Robot-supported upper limb training in a virtual learning environment : a pilot randomized controlled trial in persons with MS

Abstract

BackgroundDespite the functional impact of upper limb dysfunction in multiple sclerosis (MS), effects of intensive exercise programs and specifically robot-supported training have been rarely investigated in persons with advanced MS.AimTo investigate the effects of additional robot-supported upper limb training in persons with MS compared to conventional treatment only.MethodsSeventeen persons with MS (pwMS) (median Expanded Disability Status Scale of 8, range 3.5–8.5) were included in a pilot RCT comparing the effects of additional robot-supported training to conventional treatment only. Additional training consisted of 3 weekly sessions of 30 min interacting with the HapticMaster robot within an individualised virtual learning environment (I-TRAVLE). Clinical measures at body function (Hand grip strength, Motricity Index, Fugl-Meyer) and activity (Action Research Arm test, Motor Activity Log) level were administered before and after an intervention period of 8 weeks. The intervention group were also evaluated on robot-mediated movement tasks in three dimensions, providing active range of motion, movement duration and speed and hand-path ratio as indication of movement efficiency in the spatial domain. Non-parametric statistics were applied.ResultsPwMS commented favourably on the robot-supported virtual learning environment and reported functional training effects in daily life. Movement tasks in three dimensions, measured with the robot, were performed in less time and for the transporting and reaching movement tasks more efficiently. There were however no significant changes for any clinical measure in neither intervention nor control group although observational analyses of the included cases indicated large improvements on the Fugl-Meyer in persons with more marked upper limb dysfunction.ConclusionRobot-supported training lead to more efficient movement execution which was however, on group level, not reflected by significant changes on standard clinical tests. Persons with more marked upper limb dysfunction may benefit most from additional robot-supported training, but larger studies are needed.Trial registrationThis trial is registered within the registry Clinical Trials GOV (NCT02257606).

A Survey of Assistive Technologies for Assessment and Rehabilitation of Motor Impairments in Multiple Sclerosis

“…Upper limb training using a robot in a VR environment was also studied by Feys et al [90]. They aimed to compare the effect of robot-assisted upper limb training compared to conventional training.…”

“…Upper limb rehabilitation has been shown to have a positive effect on upper-arm functioning in persons with progressive MS [91]. Robots, like Braccio di Ferro and HapticMaster [87,88,90], have been used to assist users in rehabilitation by providing them the ability to perform multiple exercises with specific mechanical constraints. These robots can provide different kinds of forces to the its end effector, which the subjects would hold, to simulate different mechanical constraints.…”

“…Studies have shown that task-oriented training is more effective than passive training during rehabilitation to retain the white matter integrity of the brain [85]. As with gait rehabilitation, VR has also been used with upper limb rehabilitation [89,90]. Table 4 provides a summary of all the technologies discussed in this section.…”

An intelligent, adaptive, performance‐sensitive, and virtual reality‐based gaming platform for the upper limb

“…The task repository was sufficient to offer tasks that ended on completion of 30 min of task performance, similar to that reported in literature. 44…”

The efficiency of virtual reality based physiotherapy on upper limb mobility in stroke patients

“…Detekovali jsme u nich rychlejší reakce, koordinovanější a obratnější pohyby a měli větší sílu stisku ruky. V souladu s výsledky tohoto experimentu jsou i výsledky kolektivů autorů Feyse a Gijbelse (18,19), kteří navíc poukazují na výrazné zlepšení motoriky horní končetiny u pacientů s horší počáteč-ní hybností končetiny, kdy je potenciál úpravy funk- Pro hodnocení kognitivních funkcí, jež nám umožňují zpracovávat a reagovat na příchozí vjemy a jsou tedy nutností pro kvalitní fungování senzomotorického systému, jsme zvolili nejčastěji používaný a jednoduchý test MMSE (16). Z výsledků můžeme pozorovat zlepšení kognitivních funkcí u experimentální skupiny probandů.…”