Upper limb spasticity reduction following active training: A robot-mediated study in patients with chronic hemiparesis

Posteraro, Federico; Mazzoleni, Stefano; Aliboni, S.; Cesqui, Benedetta; Battaglia, Alessandro; Carrozza, Maria Chiara; Dario, P.; Micera, Silvestro

doi:10.2340/16501977-0500

Cited by 37 publications

(20 citation statements)

References 13 publications

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“…Our results confirm that the motor impairment in the upper limb of post-stroke patients improve after the rehabilitation based on a robot-aided therapy, both in chronic and subacute subjects, as demonstrated by several previous studies [22], [23], [24], [25], [26], [27], [28], [29], [30], even if clinical scales seem to detect a better recovery in subacute patients than that observed in chronic patients. The analysis of biomechanical parameters shows that also the velocity of the arm movement improves after the robotic training, in both groups (Fig.…”

Section: Resultssupporting

confidence: 92%

Mechanisms of Motor Recovery in Chronic and Subacute Stroke Patients Following a Robot-Aided Training

Mazzoleni

Puzzolante²,

Zollo

et al. 2014

IEEE Trans. Haptics

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The aim of this article is to propose a methodology for analyzing different recovery mechanisms in subacute and chronic patients through evaluation of biomechanical parameters. Twenty-five post-stroke subjects, eight subacute and seventeen chronic, participated in the study. A 2-DoF robotic system was used for upper limb training. Two clinical scales were used for assessment. Forces and velocities at the robot's end-effector during the execution of upper limb planar reaching movements were measured. Clinical outcome measures show a significant decrease in motor impairment after the treatment both in chronic and subacute patients (MSS-SE, p<0.001; FM, p<0.05). Movement velocity increases after the robot-aided treatment in both groups. Mean values of forces exerted by subacute patients are lower than those observed in chronic patients, both at the beginning and at the end of robotic treatment, as in the latter the pathological pattern is already structured. Our results demonstrate that the monitoring of the forces exerted on the end-effector during robot-aided treatment can identify the specific motor recovery mechanisms at different stages. If the pathological pattern is not yet structured, rehabilitative interventions should be addressed toward the use of motor re-learning procedures; on the other hand, if the force analysis shows a strong pathological pattern, mechanisms of compensation should be encouraged.

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Section: Resultssupporting

confidence: 92%

Mechanisms of Motor Recovery in Chronic and Subacute Stroke Patients Following a Robot-Aided Training

Mazzoleni

Puzzolante²,

Zollo

et al. 2014

IEEE Trans. Haptics

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“…At the end of the treatment (i.e., 30 sessions), FM and MI improved significantly in both groups, even if the improvement in FM was higher in the EG than in the CG after 15 sessions, confirming that intensive training provided by robotic device contributes to obtain better results than usual treatment at the early stage of rehabilitation [39]. …”

Section: Discussionmentioning

confidence: 86%

Effects of upper limb robot-assisted therapy on motor recovery in subacute stroke patients

Sale

Franceschini

Mazzoleni

et al. 2014

Journal of NeuroEngineering and Rehabilitation

123

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Background and purposeThere is little evidence available on the use of robot-assisted therapy in subacute stroke patients. A randomized controlled trial was carried out to evaluate the short-time efficacy of intensive robot-assisted therapy compared to usual physical therapy performed in the early phase after stroke onset.MethodsFifty-three subacute stroke patients at their first-ever stroke were enrolled 30 ± 7 days after the acute event and randomized into two groups, both exposed to standard therapy. Additional 30 sessions of robot-assisted therapy were provided to the Experimental Group. Additional 30 sessions of usual therapy were provided to the Control Group.The following impairment evaluations were performed at the beginning (T0), after 15 sessions (T1), and at the end of the treatment (T2): Fugl-Meyer Assessment Scale (FM), Modified Ashworth Scale-Shoulder (MAS-S), Modified Ashworth Scale-Elbow (MAS-E), Total Passive Range of Motion-Shoulder/Elbow (pROM), and Motricity Index (MI).ResultsEvidence of significant improvements in MAS-S (p = 0.004), MAS-E (p = 0.018) and pROM (p < 0.0001) was found in the Experimental Group. Significant improvement was demonstrated in both Experimental and Control Group in FM (EG: p < 0.0001, CG: p < 0.0001) and MI (EG: p < 0.0001, CG: p < 0.0001), with an higher improvement in the Experimental Group.ConclusionsRobot-assisted upper limb rehabilitation treatment can contribute to increasing motor recovery in subacute stroke patients. Focusing on the early phase of stroke recovery has a high potential impact in clinical practice.

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“…This is not very surprising, because in western physiotherapy similar concepts for hemiparesis due to different causes are used. This might be an indication that certain parts of the mechanism of acupuncture in the rehabilitation of hemiparesis are, like western physiotherapy, the activation of healthy brain tissue around the lesions or activation of reciprocal inhibition [36] or perhaps even an enhancement of neuroplasticity [37, 38]. …”

Section: Discussionmentioning

confidence: 99%

Hemiparesis after Operation of Astrocytoma Grade II in Adults: Effects of Acupuncture on Sensory-Motor Behavior and Quality of Life

Schröder

Liu

et al. 2013

Evidence-Based Complementary and Alternative Medicine

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To evaluate the effect of acupuncture on hemiparesis and quality of life for adults with brain astrocytoma grade II, we conducted a randomized, observer-blinded clinical trial. Fifty-eight patients were randomized to standard rehabilitation (SR) therapy without acupuncture (n = 20), SR plus standard acupuncture (SA) (n = 19), and SR plus individualized acupuncture (IA) (n = 19). SA points were PC6, SP6, HT1, LU5, BL40, and ST36, while a special concept called “connecting and regulation Ren and Du” and “Jin-3-needling” served as IA. This treatment was individualized according to the clinical syndrome. The outcome was measured by the Barthel Index (BI), the Fugl-Meyer scale (FM), and the EORTC Core Quality of Life Questionnaire (QLQ-C30) with the Brain Cancer Module (BCM20). IA + SR reached significantly higher BI scores than SA + SR, which reached significantly higher BI scores than SR. IA + SR was significantly superior to SA + SR and to SR at the 8th week for the scores of FM motor and sensory assessments and most QLQ-C30-BCM20 items. In conclusion, the individualized acupuncture concept of “connecting and regulating Ren and Du” combined with “Jin-3-needling” offers a promising possibility for the treatment of hemiparesis due to astrocytoma, but further evaluation is mandatory.

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Upper limb spasticity reduction following active training: A robot-mediated study in patients with chronic hemiparesis

Cited by 37 publications

References 13 publications

Mechanisms of Motor Recovery in Chronic and Subacute Stroke Patients Following a Robot-Aided Training

Mechanisms of Motor Recovery in Chronic and Subacute Stroke Patients Following a Robot-Aided Training

Effects of upper limb robot-assisted therapy on motor recovery in subacute stroke patients

Hemiparesis after Operation of Astrocytoma Grade II in Adults: Effects of Acupuncture on Sensory-Motor Behavior and Quality of Life

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