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ObjectiveTo investigate the effect of transcutaneous auricular vagus nerve stimulation (taVNS) combined with robot-assisted therapy on upper limb function of subacute stroke patients. MethodsFrom March, 2022 to March, 2023, 60 subacute stroke patients from Dushu Lake Hospital and the First People's Hospital of Kunshan were randomly divided into control group (n = 20), robot group (n = 20) and combined group (n = 20). All the groups received conventional treatments including medication, physical therapy and occupational therapy; the robot group received sham taVNS combined with hand robot-assisted therapy; while the combined group received taVNS combined with hand robot-assisted therapy, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and hand part, the root mean square (RMS) electromyography of the extensor carpi radialis and extensor digitorum muscles during contraction, and the latency and amplitude of transcranial magnetic stimulation motor-evoked potential (TMS-MEP) before and after treatment. ResultsAfter treatment, the scores of FMA-UE and hand part, RMS of the extensor carpi radialis and extensor digitorum muscles, and latency and amplitude of TMS-MEP improved in all the groups (t > 2.099, P < 0.05); and they were the best in all indicators in the combined group (F > 9.106, P < 0.001). ConclusiontaVNS combined with robot-assisted therapy can promote central nervous system remodeling and further improve upper limb function in stroke patients.
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Objective:To explore the appropriate use of a self-developed scoliosis rehabilitation robot in treating adolescent idiopathic scoliosis (AIS), and also its safety and effectiveness.Methods:The scoliosis rehabilitation robot consists of a closed-loop pneumatic control system and multi-segment torso, pelvis and upper extremity fixation devices. It provides three-dimensional synchronous correction. Eighteen AIS subjects first received 30min of robot-assisted treatment using the maximum tolerable orthotic force. The angles of their spinal processes were evaluated using ultrasound before the treatment and after 30 seconds, 5 minutes and 30 minutes of treatment, then 5min later. In a second 30sec course of treatment the transverse orthotic force was 10%, 15%, 20%, 25%, and 30% of the patient′s body weight. Any adverse effects were observed and recorded.Results:The robot ran smoothly and could apply intelligent and precise correction. No severe adverse effects were reported. The mean correction of the spinal process angles showed a significant cumulative effect with treatment time, reaching 104% at 30min. The mean process angle correction increased with the applied force. Force at 25% of the patient′s weight produced an average correction of 104% in patients with mild AIS and 65% in those whose AIS was moderate.Conclusion:The scoliosis rehabilitation robot is safe and immediately effective. Setting the transverse force at 25% of a patient′s weight gives the best corrective effect with mild AIS. Moderate AIS requires more force.
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Objective:To explore the effects of robot-assisted therapy combined with mirror therapy (MT) on upper limbs in patients with hemiplegia after stroke. Methods:From January, 2017 to June, 2018, 56 patients with hemiplegia after stroke were randomly divided into control group (n = 28) and observation group (n = 28). The control group received conventional therapy, and the treatment group received robot-assisted therapy combined with MT, additionally. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Wolf Motor Function Test (WMFT), Functional Independence Measure (FIM) and modified Barthel Index (MBI) before and four weeks after treatment. Results:Four weeks after treatment, the scores of FMA-UE, WMFT and MBI were better in both groups (t > 2.959, P < 0.05), and were better in the observation group than in the control group (t > 4.732, P < 0.001). Conclusion:Robot-assisted therapy combined with MT could improve the function of upper limb and activities of daily living in patients with hemiplegia after stroke.
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Recently, rehabilitation robotics technology has advanced, and several therapeutic robots have been developed. Robot-assisted rehabilitation therapy has a number of advantages over manual physical therapy. It can relieve the physical therapist from the strenuous task of manual assistance and provide high-dosage and high-intensity training. Therapeutic rehabilitation robots include end-effector and exoskeleton types, which are mainly applied for rehabilitation of upper extremity motor dysfunction or gait disturbance. In addition, they are used for patients with stroke, traumatic brain injury, spinal cord injury, parkinsonism, and cerebral palsy. Several studies have reported that robot-assisted therapy has a beneficial effect on motor function in patients with impaired motor function, either alone or as an additional therapeutic tool in combination with conventional rehabilitation therapy. We believe that ongoing improvement in robotic technology will help to overcome the disadvantages of conventional rehabilitation therapy and to optimize rehabilitation therapies for disabled patients.
Subject(s)
Humans , Brain Injuries , Cerebral Palsy , Gait , Parkinsonian Disorders , Physical Therapists , Rehabilitation , Robotics , Spinal Cord Injuries , Stroke , Upper ExtremityABSTRACT
Objective To study the effects of robot-assisted therapy combined with electromyographic biofeedback (EMGBF) on upper limb function after stroke.Methods Thirty acute stroke patients were randomly divided into two groups of 15.The patients in the control group received a conventional rehabilitation program and EMGBF.The patients in the treatment group received robot-assisted therapy for 30 minutes daily,6 days a week for 3 weeks combined with EMGBF on the basis of the conventional rehabilitation program.Upper limb motor function and ability in the activities of daily living (ADL) were assessed with the Fugl-Meyer upper extremity assessment (FMA) and a functional independence measure (FIM) before treatment,at 3 weeks and 3 months after treatment.Results After treatment the FMA and FIM scores of both groups were significantly better than before treatment.At 3 weeks after treatment there was no significant difference in the average FMA scores of the two groups,but at 3 months after treatment the patients in the treatment group had significantly better scores.No significant differences in FIM scores were observed at 3 weeks or 3 months.Conclusions Robot-assisted therapy combined with EMGBF can improve upper limb motor function significantly in acute stroke patients,and more effectively than EMGBF.But no significant advantage in improvement in ADL performance was observed with Robot-assisted therapy combined with EMGBF over EMGBF.
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Research into rehabilitation robotics has grown rapidly and the number of therapeutic rehabilitation robots has expanded dramatically during the last two decades. Robotic rehabilitation therapy can deliver high-dosage and high-intensity training, making it useful for patients with motor disorders caused by stroke or spinal cord disease. Robotic devices used for motor rehabilitation include end-effector and exoskeleton types; herein, we review the clinical use of both types. One application of robot-assisted therapy is improvement of gait function in patients with stroke. Both end-effector and the exoskeleton devices have proven to be effective complements to conventional physiotherapy in patients with subacute stroke, but there is no clear evidence that robotic gait training is superior to conventional physiotherapy in patients with chronic stroke or when delivered alone. In another application, upper limb motor function training in patients recovering from stroke, robot-assisted therapy was comparable or superior to conventional therapy in patients with subacute stroke. With end-effector devices, the intensity of therapy was the most important determinant of upper limb motor recovery. However, there is insufficient evidence for the use of exoskeleton devices for upper limb motor function in patients with stroke. For rehabilitation of hand motor function, either end-effector and exoskeleton devices showed similar or additive effects relative to conventional therapy in patients with chronic stroke. The present evidence supports the use of robot-assisted therapy for improving motor function in stroke patients as an additional therapeutic intervention in combination with the conventional rehabilitation therapies. Nevertheless, there will be substantial opportunities for technical development in near future.