The Armeo Spring as training tool to improve upper limb functionality in multiple sclerosis: a pilot study

Domien Gijbels, Ilse Lamers, Lore Kerkhofs, Geert Alders, Els Knippenberg, Peter Feys, Domien Gijbels, Ilse Lamers, Lore Kerkhofs, Geert Alders, Els Knippenberg, Peter Feys

Abstract

Background: Few research in multiple sclerosis (MS) has focused on physical rehabilitation of upper limb dysfunction, though the latter strongly influences independent performance of activities of daily living. Upper limb rehabilitation technology could hold promise for complementing traditional MS therapy. Consequently, this pilot study aimed to examine the feasibility of an 8-week mechanical-assisted training program for improving upper limb muscle strength and functional capacity in MS patients with evident paresis.

Methods: A case series was applied, with provision of a training program (3×/week, 30 minutes/session), supplementary on the customary maintaining care, by employing a gravity-supporting exoskeleton apparatus (Armeo Spring). Ten high-level disability MS patients (Expanded Disability Status Scale 7.0-8.5) actively performed task-oriented movements in a virtual real-life-like learning environment with the affected upper limb. Tests were administered before and after training, and at 2-month follow-up. Muscle strength was determined through the Motricity Index and Jamar hand-held dynamometer. Functional capacity was assessed using the TEMPA, Action Research Arm Test (ARAT) and 9-Hole Peg Test (9HPT).

Results: Muscle strength did not change significantly. Significant gains were particularly found in functional capacity tests. After training completion, TEMPA scores improved (p = 0.02), while a trend towards significance was found for the 9HPT (p = 0.05). At follow-up, the TEMPA as well as ARAT showed greater improvement relative to baseline than after the 8-week intervention period (p = 0.01, p = 0.02 respectively).

Conclusions: The results of present pilot study suggest that upper limb functionality of high-level disability MS patients can be positively influenced by means of a technology-enhanced physical rehabilitation program.

Figures

Figure 1
Figure 1
The Armeo Spring, an exoskeleton apparatus with integrated spring mechanism allowing variable upper limb gravity support. Photograph courtesy of Hocoma AG.
Figure 2
Figure 2
Effects of Armeo Spring training on upper limb functional capacity parameters. Changes in outcome measures (Δ) were measured after 8 weeks of training (POST) and at 2-month follow-up (FU), relative to baseline (PRE). Vertical bars show 1 standard error; *p < 0.05; + trend towards significance. ARAT, Action Research Arm Test; 9HPT, 9-Hole Peg Test.
Figure 3
Figure 3
Case profiles of time performance on the TEMPA. Outcomes were measured at baseline (PRE), after 8 weeks of Armeo Spring training (POST), and at 2-month follow-up (FU). P, patient.

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