Robotic unilateral and bilateral upper-limb movement training for stroke survivors afflicted by chronic hemiparesis

Abstract

Stroke is the leading cause of long-term neurological disability and the principle reason for seeking rehabilitative services in the US. Learning based rehabilitation training enables independent mobility in the majority of patients post stroke, however, restoration of fine manipulation, motor function and task specific functions of the hemiplegic arm and hand is noted in fewer than 15% of the stroke patients. Brain plasticity is the innate mechanism enabling the recovery of motor skills through neurological reorganization of the brain as a response to limbs' manipulation. The objective of this research was to evaluate the therapeutic efficacy for the upper limbs with a dual arm exoskeleton system (EXO-UL7) using three different modalities: bilateral mirror image with symmetric movements of both arms, unilateral movement of the affected arm and standard care. Five hemiparetic subjects were randomly assigned to each therapy modality. An upper limb exoskeleton was used to provide bilateral and unilateral treatments. Standard care was provided by a licensed physical therapist. Subjects were evaluated before and after the interventions using 13 different clinical measures. Following these treatments all of the subjects demonstrated significant improved of their fine motor control and gross control across all the treatment modalities. Subjects exhibited significant improvements in range of motion of the shoulder, and improved muscle strength for bilateral training and standard care, but not for unilateral training. In conclusion, a synergetic approach in which robotic treatments (unilateral and bilateral depending on the level of the motor control) are supplemented by the standard of care may maximize the outcome of the motor control recover following stroke.

Effectiveness of robot therapy on body function and structure in people with limited upper limb function: A systematic review and meta-analysis

“…The duration of RT ranged from 2[ 25 ] to 20[ 57 ] weeks, and the frequency per week varied from 2[ 16 , 18 ] to 6[ 57 ] days. The time spent per session of intervention ranged from 0.2[ 40 ] to 2[ 57 ] hours.…”

“…Thirty-five studies evaluated motor control using three different instruments. Of these 35 studies, 33 (94.2%)[ 15 , 16 , 18 – 27 , 35 – 38 , 40 – 41 , 44 – 59 ] used the Fugl Meyer (FM), two studies (5.7%)[ 34 , 42 ] used the Chedoke McMaster Stroke Assessment (CMSA). Fourteen studies[ 15 – 17 , 20 , 25 , 26 , 38 , 40 , 43 , 46 , 48 , 50 , 51 , 55 ] evaluated spasticity using the Modified Ashworth Scale (MAS).…”

“…Twenty-one studies evaluated strength using six different instruments. Of these 21 studies, seven (33.3%)[ 15 , 21 , 39 , 40 , 46 , 51 , 58 ] used the Medical Research Council (MRC), three (14.2%)[ 41 , 43 , 49 ] used the hand-held dynamometer, six (28.5%)[ 17 , 20 , 25 , 35 , 54 , 55 ] used the Motor Power Scale (MP), two (9.5%) used the Manual Muscle Testing (MMT)[ 16 , 18 ] and the WAM control program[ 56 , 57 ], and one study[ 51 ] used the Motricity Index (MI). To homogenize the data, Newton and kilogram-force values were converted into pounds.…”

“…Five studies evaluated range of motion using three different measures. Of these 5 studies, three studies (60.0%)[ 16 , 18 , 50 ] assessed range of motion using goniometer, one study[ 57 ] used the WAM control program, and one study[ 41 ] used the mean distance between a marker placed on the participant’s wrist and five targets. Six studies evaluated pain using three different instruments.…”

Neuroplastic changes in resting-state functional connectivity after stroke rehabilitation

“…Recent evidence also reveals that repetitive bimanual movements can increase the excitability of the ipsilesional M1 to inhibit the contralesional M1, which promotes a rebalancing of mutual transcallosal connections and enhances motor and functional recovery (Simkins et al, 2013 ; Stinear et al, 2014 ). Here, a greater improvement in the pre-to-post difference in M1-M1 RS-FC was coupled with better motor and functional gains after RBAT was completed.…”