Translational effects of robot-mediated therapy in subacute stroke patients: an experimental evaluation of upper limb motor recovery

Eduardo Palermo, Darren Richard Hayes, Emanuele Francesco Russo, Rocco Salvatore Calabrò, Alessandra Pacilli, Serena Filoni, Eduardo Palermo, Darren Richard Hayes, Emanuele Francesco Russo, Rocco Salvatore Calabrò, Alessandra Pacilli, Serena Filoni

Abstract

Robot-mediated therapies enhance the recovery of post-stroke patients with motor deficits. Repetitive and repeatable exercises are essential for rehabilitation following brain damage or other disorders that impact the central nervous system, as plasticity permits to reorganize its neural structure, fostering motor relearning. Despite the fact that so many studies claim the validity of robot-mediated therapy in post-stroke patient rehabilitation, it is still difficult to assess to what extent its adoption improves the efficacy of traditional therapy in daily life, and also because most of the studies involved planar robots. In this paper, we report the effects of a 20-session-rehabilitation project involving the Armeo Power robot, an assistive exoskeleton to perform 3D upper limb movements, in addition to conventional rehabilitation therapy, on 10 subacute stroke survivors. Patients were evaluated through clinical scales and a kinematic assessment of the upper limbs, both pre- and post-treatment. A set of indices based on the patients' 3D kinematic data, gathered from an optoelectronic system, was calculated. Statistical analysis showed a remarkable difference in most parameters between pre- and post-treatment. Significant correlations between the kinematic parameters and clinical scales were found. Our findings suggest that 3D robot-mediated rehabilitation, in addition to conventional therapy, could represent an effective means for the recovery of upper limb disability. Kinematic assessment may represent a valid tool for objectively evaluating the efficacy of the rehabilitation treatment.

Keywords: Kinematics; Post-stroke hemiparesis; Robot-mediated rehabilitation; Robotic-assisted therapy; Sub-acute.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1. The Hocoma Armeo ® Power.
Figure 1. The Hocoma Armeo®Power.
A six degrees of freedom (DoFs) exoskeleton: three DoFs for the shoulder, one for the elbow flexion, one for the forearm supination, and one for the wrist flexion. Each joint is powered by a motor and equipped with two angle sensors (Photo: E F Russo).
Figure 2. Subject performing the reaching task.
Figure 2. Subject performing the reaching task.
Reflective markers are placed on the body according to the kinematic model adopted. A reflective marker is also placed on the target, installed on a rod in front of the subject, at the height of the shoulders. The rod was moved at every trial to align the target with the shoulder performing the reaching task (Photo: E F Russo).
Figure 3. Kinematic model for reflective marker…
Figure 3. Kinematic model for reflective marker placement adopted in this study.
A total of 12 markers (14 mm diameter) are placed over prominent bony landmarks of the upper extremity, easily identifiable, and reproducible, where subcutaneous tissue is thin, minimizing soft tissue artifact due to marker movement with respect to bone.
Figure 4. Example of hand trajectories.
Figure 4. Example of hand trajectories.
Hand trajectories (in blue) during the reaching task, with respect to the shortest path (in red). (A) Reaching trajectory of the paretic arm before the treatment. (B) Reaching trajectory of the paretic arm after the treatment. (C) Trajectory of the unaffected arm.
Figure 5. Mean value of the NJ…
Figure 5. Mean value of the NJ of hand trajectories for the ten patients across the different trials.
The bars represent the standard deviation (±). For each patient, values obtained with the affected arm before the treatment (green) are compared to those obtained with the same arm after the treatment (blue). Values obtained with the unaffected arm are also reported for visual comparison (yellow).
Figure 6. Mean values of the six…
Figure 6. Mean values of the six kinematic indices calculated across all the patients.
(A) MT; (B) PV; (C) TtPV; (D) NJ; (E) TD; (F) HPR. Error bars represent the standard deviation (±). For each index, mean values obtained with the affected arm before the treatment are depicted in green. Values obtained with the same arm after the treatment are reported in blue. Statistical significance between the two conditions are starred. For visual comparison, values obtained with the non-affected arm are also reported in yellow.

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