Dose and staffing comparison study of upper limb device-assisted therapy

Abstract

BACKGROUND: Neurological injuries cause persistent upper extremity motor deficits. Device-assisted therapy is an emerging trend in neuro-rehabilitation as it offers high intensity, repetitive practice in a standardized setting. OBJECTIVE: To investigate the effects of therapy duration and staff-participant configuration on device-assisted upper limb therapy outcomes in individuals with chronic paresis. METHODS: Forty-seven participants with chronic upper extremity weakness due to neurological injury were assigned to a therapy duration (30 or 60 min) and a staff-participant configuration (1-to-1 or 1-to-2). Therapy consisted of 3 sessions a week for 6 weeks using the Armeo ® Spring device. Clinical assessments were performed at three timepoints (Pre, Post, and 3 month Follow up). RESULTS: Improvements in upper limb impairment, measured by change in Fugl-Meyer score (FM), were observed following therapy in all groups. FM improvement was comparable between 30 and 60 min sessions, but participants in the 1-to-2 group had significantly greater improvement in FM from Pre-to-Post and from Pre-to-Follow up than the 1-to-1 group. CONCLUSIONS: Device-assisted therapy can reduce upper limb impairment to a similar degree whether participants received 30 or 60 min per session. Our results suggest that delivering therapy in a 1-to-2 configuration is a feasible and more effective approach than traditional 1-to-1 staffing.

Comparing a Novel Neuroanimation Experience to Conventional Therapy for High-Dose Intensive Upper-Limb Training in Subacute Stroke: The SMARTS2 Randomized Trial

“…Thus, based on the results here, we suggest that an alternative to just increasing the amount of time available to administer COT is to devise technology-based solutions that are scalable and that make it easier and more enjoyable to deliver higher doses and intensities of impairment-focused therapy. 54 It should also be emphasized that even though in this small study we found no significant difference between COT and NAT for delivery of higher doses of intense upper-limb therapy, it does not need to be either/or. It may turn out that the 2 approaches can complement each other.…”

Comparing a novel neuroanimation experience to conventional therapy for high-dose, intensive upper-limb training in subacute stroke: The SMARTS2 randomized trial

“…The protocol change would be, as in SMARTS2, to encourage exploratory multi-joint movements outside of a task context for at least two hours a day. Thus, based on the results here, we suggest that an alternative to just increasing the amount of time available to administer COT, is to devise technology-based solutions that make it easier and more enjoyable to deliver higher doses and intensities of impairment-focused therapy 54 . It should also be emphasized, that even though in this small study we found equivalence between COT and NAT for delivery of higher doses of intense upper limb therapy, it does not need to be either/or.…”

Automated patient-robot assignment for a robotic rehabilitation gym: a simplified simulation model

“…The objective (10) maximizes the total skill acquisition across all patients during the training session, where is the skill improvement function. While function (16) appears slightly different than function (9), this is only because of the difference in the variables used to model the disjunctive and time-indexed models. Both Eqs.…”

“…To reduce the burden on the therapist, such two-robot setups commonly include automated difficulty adaptation algorithms that aim to keep the exercise difficulty appropriate for both patients [13][14][15], removing the need for the therapist to constantly modify the exercise settings. Short-term studies have shown benefits to such paired rehabilitation such as improved motivation, exercise intensity and motor learning [7][8][9][10][11][12], and a recent clinical trial found greater improvements in functional outcome after paired therapy than after individual therapy [16].…”