The effect of mirror therapy can be improved by simultaneous robotic assistance.

BACKGROUND: Standard mirror therapy (MT) is a well-established therapy regime for severe arm paresis after acquired brain injury. Bilateral robot-assisted mirror therapy (RMT) could be a solution to provide visual and somatosensory feedback simultaneously. OBJECTIVE: The study compares the treatment effects of MT with a version of robot-assisted MT where the affected arm movement was delivered through a robotic glove (RMT). METHODS: This is a parallel, randomized trial, including patients with severe arm paresis after stroke or traumatic brain injury with a Fugl-Meyer subscore hand/finger < 4. Participants received either RMT or MT in individual 30 minute sessions (15 sessions within 5 weeks). Main outcome parameter was the improvement in the Fugl-Meyer Assessment upper extremity (FMA-UE) motor score. Additionally, the Motricity Index (MI) and the FMA-UE sensation test as well as a pain scale were recorded. Furthermore, patients' and therapists' experiences with RMT were captured through qualitative tools. RESULTS: 24 patients completed the study. Comparison of the FMA-UE motor score difference values between the two groups revealed a significantly greater therapy effect in the RMT group than the MT group (p = 0.006). There were no significant differences for the MI (p = 0.108), the FMA-UE surface sensibility subscore (p = 0.403) as well as the FMA-UE position sense subscore (p = 0.192). In both groups the levels of pain remained stable throughout the intervention. No other adverse effects were observed. The RMT training was well accepted by patients and therapists. CONCLUSIONS: The study provides evidence that bilateral RMT achieves greater treatment benefit on motor function than conventional MT. The use of robotics seems to be a good method to implement passive co-movement in clinical practice. Our study further demonstrates that this form of training can feasibly and effectively be delivered in an inpatient setting.

Effect on arm function and cost of robot-assisted group therapy in subacute patients with stroke and a moderately to severely affected arm: a randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness and efficiency of robot-assisted arm group therapy (RAGT) versus individual arm therapy (IAT) to restore motor function in the moderately to severely affected patient after stroke. DESIGN: Single blind randomized controlled trial. SETTING: Two in-patient neurological rehabilitation centers. PARTICIPANTS: Fifty first time subacute patients with stroke and a non-functional hand. INTERVENTION: The patients practiced either 30 minutes of RAGT + 30 minutes of IAT (group A) or 2x30 minutes of IAT (group B), per workday for four weeks. The RAGT consisted of six workstations enabling repetitive practice of finger, wrist, forearm and shoulder movements. Patients practiced according to their impairment level on at least two workstations per session. The IAT followed the Motor Relearning Programme, enriched by elements of the impairment-oriented training. MAIN OUTCOME MEASURE: Changes of the Fugl Meyer Score (FM, 0-66) between baseline and after 4 weeks, incremental cost effectiveness. RESULTS: Patients were homogeneous at study onset. All patients improved their upper limb motor function over time, but there were no between group differences. The initial (terminal) FM scores were 14.6±9.4 (25.7±16.5) in group A and 16.5±9.8 (31.1±19.1) in group B. The treatment of a single patient with RAGT cost 4.15 €, compared to 10.00 € for a patient to receive IAT. CONCLUSION: RAGT in combination with IAT was equally effective as a double session of IAT regarding the restoration of upper limb motor functions in moderate to severely affected subacute patients with stroke. The treatment costs for RAGT were less.

Ageing and mental health resources for older persons in the African region of the World Health Organization

Africa is a region where a demographic transition from high child mortality and low life expectancy; to low child mortality and high life expectancy is only just beginning.Nevertheless; some countries already have a growing number of persons over the age of 60 - a number that is likely to increase rapidly. As a consequence; the number of older persons with mental disorders is likely to increase. To better understand the organisation of care for older persons; data are being collected to reduce the imbalance between 'disease information' and 'resource information' - information that addresses older persons' needs in terms of mental health care.This review presents some results from the continent. Mental health problems among older adults are still not a public health priority in Africa; but careful examination of each country nevertheless reveals certain specificities; such as divergent life expectancy and different values regarding ageing. The authors present some recommendations for the development of carefor old persons with mental disorders; based on the general recommendations made by the World Health Organization (WHO) in the World Health Report 2001 (WHR 2001); and by the WHO and the World Psychiatric Association (WPA) in some consensus statements on psychiatry of the elderly