Short-term and long-term outcomes of serial robotic training for improving upper limb function in chronic stroke.

The aim of this study was to determine short-term and long-term changes in motor function in patients with chronic hemiparesis who underwent robot training and to evaluate its long-term benefit after 6 months. This was a longitudinal study with a 6-month follow-up. The 15 patients included in this study underwent the Fugl-Meyer test, the Ashworth Scale test, the Frenchay Arm test, and the Box and Block test according to the following schedule: immediately before (T1, T3) and after each treatment (T2, T4), and 6 months after T4 (T5). There were statistically significant improvements in Fugl-Meyer test between T1 and T2 and between T1 and T4; the score increased in the Ashworth Scale test for Shoulder between T1 and T3 and between T1 and T5; a statistically significant decrease was found between T1 and T2 and between T1 and T4, in the Box and Block test between T1 and T4, and also between T1 and T5. This original rehabilitation treatment may contribute toward increasing upper limb motor recovery in stable chronic stroke patients.

Systematic review of outcome measures of walking training using electromechanical and robotic devices in patients with stroke.

OBJECTIVE: The aim of this systematic review was to identify appropriate selection criteria of clinical scales for future trials, starting from those most commonly reported in the literature, according to their psychometric properties and International Classification of Functioning, Disability and Health (ICF) domains. DATA SOURCES: A computerized literature research of articles was conducted in MEDLINE, EMBASE, CINALH, PubMed, PsychINFO and Scopus databases. STUDY SELECTION: Clinical trials evaluating the effects of electromechanical and robot-assisted gait training trials in stroke survivors. DATA EXTRACTION: Fifteen independent authors performed an extensive literature review. DATA SYNTHESIS: A total of 45 scales was identified from 27 studies involving 966 subjects. The most commonly used outcome measures were: Functional Ambulation Category (18 studies), 10-Meter Walking Test (13 studies), Motricity Index (12 studies), 6-Minute Walking Test (11 studies), Rivermead Mobility Index (8 studies) and Berg Balance Scale (8 studies). According to the ICF domains 1 outcome measure was categorized into Body Function and Structure, 5 into Activity and none into Participation. CONCLUSION: The most commonly used scales evaluated the basic components of walking. Future studies should also include instrumental evaluation. Criteria for scale selection should be based on the ICF framework, psychometric properties and patient characteristics.

Walking performance: correlation between energy cost of walking and walking participation. new statistical approach concerning outcome measurement.

Walking ability, though important for quality of life and participation in social and economic activities, can be adversely affected by neurological disorders, such as Spinal Cord Injury, Stroke, Multiple Sclerosis or Traumatic Brain Injury. The aim of this study is to evaluate if the energy cost of walking (CW), in a mixed group of chronic patients with neurological diseases almost 6 months after discharge from rehabilitation wards, can predict the walking performance and any walking restriction on community activities, as indicated by Walking Handicap Scale categories (WHS). One hundred and seven subjects were included in the study, 31 suffering from Stroke, 26 from Spinal Cord Injury and 50 from Multiple Sclerosis. The multivariable binary logistical regression analysis has produced a statistical model with good characteristics of fit and good predictability. This model generated a cut-off value of.40, which enabled us to classify correctly the cases with a percentage of 85.0%. Our research reveal that, in our subjects, CW is the only predictor of the walking performance of in the community, to be compared with the score of WHS. We have been also identifying a cut-off value of CW cost, which makes a distinction between those who can walk in the community and those who cannot do it. In particular, these values could be used to predict the ability to walk in the community when discharged from the rehabilitation units, and to adjust the rehabilitative treatment to improve the performance.

Robot-aided therapy for upper limbs in patients with stroke-related lesions. Brief report of a clinical experience.

This study was aimed at verifying the improvement on the motor impairment and functionality in 19 patients with chronic hemiparesis after stroke treated with a robot-aided rehabilitation protocol using the ReoGo™ system (Motorika Medical Ltd, Israel), and at evaluating the persistence of the effects after 1 month. The study also focused on the actual possibility of administering the robot-aided therapy with the ReoGo™ for the upper limbs and on the patients' degree of acceptance and compliance with the treatment. Subjects underwent an assessment prior to the start of the rehabilitation project (T-1), one at the start (T0), one at the end of the treatment (T1) and one after one month from the end of the treatment (T2). The following tests were administered: (i) Fugl-Meyer (FM) upper limb; Ashworth scale (AS); Functional Independence Measure (FIM™) (T-1 - T2); (ii) strength evaluation; Visual Analogue Scale (VAS) for pain; Frenchay Arm test (FAT); Box and Block test (BBT); Timed Up and Go (TUG) test (T0 - T2). Additionally, the Euro-QoL questionnaire and a VAS for the treatment satisfaction were administered to the subjects. Non-statistical difference of scores at T-1 and T0 on almost the entire battery of tasks suggested a stable patients' performance prior to the start of the rehabilitation. With the exception of the Medical Research Council (MRC) and the AS sub-scales measuring -as appropriate- strength and spasticity of the shoulder, triceps and wrist, all scores showed a significant increase between T0 and T1. The improvement on the pain could not be proved significant (p = 0.10). A significant increase between T0 and T2 was found for all assessment scores, with the exception of the MRC for external shoulder rotators (p = 0.05) and of the AS for shoulder (p = 0.32) and wrist (p = 0.08). Substantial stability was observed between T1 and T2. Patients were capable of completing the treatment and showed good participant satisfaction. This pilot study led to the finding of a clinical improvement and excellent patients compliance. It is possible that the learning process experienced by the patients was robot-dependent, especially in consideration of the general maintenance of the achievements observed on all activities.

Cost of walking, exertional dyspnoea and fatigue in individuals with multiple sclerosis not requiring assistive devices.

OBJECTIVE: To assess the cost of walking in individuals with multiple sclerosis and to investigate its relationship with dyspnoea and fatigue. METHODS: In 46 individuals with multiple sclerosis and in 36 healthy controls, the cost of walking was measured during the 6-min walk test. Perceived breathlessness after walking was rated on a visual analogue scale and corrected for the distance walked. The subjects' perceived effect of fatigue was assessed by means of the Modified Fatigue Impact Scale. RESULTS: The cost of walking was significantly higher in individuals with multiple sclerosis than in controls; however, individuals with multiple sclerosis with normal walking speeds had normal costs of walking. The cost of walking was directly related to the degree of disability, but not to breathlessness perception and fatigue. Individuals with an Expanded Disability Status Scale score greater than 2.5 were highly likely to show an increased cost of walking. Breathlessness perception was higher than in controls and was related to fatigue. CONCLUSION: Individuals with multiple sclerosis, even with mild disability and not requiring any assistive devices, may have an increase in cost of walking. This suggests that an aerobic training programme should be considered in these patients. Energy expenditure when walking is not a determinant of fatigue or exertional dyspnoea in individuals with multiple sclerosis and low levels of disability.

Robot therapy for functional recovery of the upper limbs: a pilot study on patients after stroke.

OBJECTIVE: To verify the possibility of administering robot-aided therapy for the upper limbs in patients after stroke; to evaluate patients' degree of acceptance and compliance with the treatment; to establish if the treatment has an effect on motor impairment and functional outcome. DESIGN: Quasi-experimental, uncontrolled study. SUBJECTS: Fourteen patients with chronic hemiparesis after stroke. METHODS: Patients were treated with a robotic system for the upper limbs (ReoGo; Motorika Medical Ltd, Israel). Subjects performed the following assessment, at the start (T0), at the end of treatment (T1), and at the follow-up performed one month after the end of treatment (T2): Fugl-Meyer test (FM) for upper limbs; strength evaluation; Ashworth scale; visual analogue scale (VAS) for pain; Frenchay Arm test (FAT); Box and Block test (B & B); Functional Independence Measure (FIM); ABILHAND Questionnaire; Timed Up and Go test (TUG); Euro-Quality of Life questionnaire and; a VAS for treatment satisfaction were administered to the subjects. RESULTS: Total scores of FM, B&B, FAT and FIM showed a statistically significant improvement from T0 and T1 (FM p < 0.002, B&B p < 0.012, FAT p < 0.023, FIM p < 0.007) and from T0 and T2 (FM p < 0.003, B&B p < 0.011, FAT p < 0.024, FIM p < 0.027). No statistically significant differences were found between evaluations at T1 and T2 (FM p < 0.595, B&B p < 0.491, FAT p < 0.317, FIM p < 0.180). CONCLUSION: The sample was capable of completing the treatment and demonstrated good participant satisfaction. This pilot study led to the finding of a clinical improvement and excellent patient compliance. It can be hypothesized that the results are robot-dependent and that they were learned and then maintained. However, the study is limited in that a control group was not used. As such, it is desirable to continue this study with a control group, as well as by designing a prospective longitudinal randomized controlled trial study.