Effects of Initial Exposure to Upper Limbrobot-Assisted Therapy in Stroke Patients

Effects of initial exposure to upper limbrobot-assisted therapy in stroke patients

Stefano Mazzoleni1,2, Rossella Crecchi2,3, Elisa Falchi2,3, Paolo Dario1,2, Federico Posteraro2,3

1The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy

2Laboratory of Rehabilitation Bioengineering, Volterra, Italy

3Neurological Rehabilitation Unit, Auxilium Vitae Rehabilitation Centre, Volterra, Italy

Introduction

Several studies on robot-assisted rehabilitation treatment in subacute and chronic stroke patients have shown a reduction of upper limb impairment [1], but till now an evidence of the advantage in the use of robotic therapy compared to traditional standard treatment is not still proved.Recent systematic reviews showed that upper limb robotic treatments in stroke subjects can improve short- and long-term motor control, even if impact on functional tasks is not demonstrated yet [1]-[2].

Methods

Twelve subacute stroke subjects (4M, age 49-77, 67.1±10.2 yrs)were recruited for the study. Five had right hemiparesis. They had experienced the acute event 25±7 days prior to the study.

Twelve chronic stroke subjects (6M, age 31–86, 60.9±13.6 yrs) were recruited for the study. Eight had right hemiparesis. They had experienced the acute event at least one year prior to the study (mean time from onset of neurological damage 24 months).The InMotion 2.0 robotic system (Interactive Motion Technologies, Inc., Watertown, MA, USA) was used for this study. Each subject was asked to perform goal-directed, planar reaching tasks, which emphasized shoulder and elbow movements, moving from the centre target to each of 8 peripheral targets. Each subject performed five sessions per week (subacute: 6 wks, chronic: 4 wks).

Results

A significant decrease in motor impairment of subacute patients following robot-assisted treatment. In chronic patients statistically significant improvements were found in Fugl-Meyer and pROM as well.Kinematic parameters recorded in subacute patients showsignificant improvements. On the other hand, any significant improvements on kinematic parameters within the first 15 sessions were not observed in chronic patients.The evaluation of kinematic parameters show significant improvements only in subacute patients.

Discussion and Conclusion

Our preliminary results show that robotic therapy assessed at half of the entire rehabilitation duration contribute to improve upper limb motor abilities in both subacute and chronicpatients.Chronic patients require a longer exposure to the robot-assisted therapy to achieve significant improvements.

References

[1]G. Kwakkel, B.J. Kollen, and H.I. Krebs, “Effects of robot-assisted therapy on upper limb recovery after stroke: a systematic review,” Neurorehabil Neural Repair, vol. 22, no. 2, pp. 111-21, 2008.

[2]G.B. Prange, M.J. Jannik, C.G. Groothuis-Oudshoorn, H.J. Hermens, and M.J. Ijzerman, “Systematic review of the effects of robot-aided therapy on recovery of the hemiparetic arm after stroke,” J Rehabil Res Dev., vol. 43, no. 2, pp. 171-84, 2006.