Effects of High-intensity Robot-assisted Hand Training on Upper Limb Recovery and Muscle Activity in Individuals With Multiple Sclerosis: A Randomized, Controlled, Single-Blinded Trial

Abstract

Background : Integration of robotics and upper limb rehabilitation in people with multiple sclerosis (PwMS) has rarely been investigated.Objective: To compare the effects of robot-assisted hand training against non-robotic hand training on upper limb activity in PwMS. To compare the training effects on hand dexterity, muscle activity, and upper limb dysfunction as measured with the International Classification of Functioning.Methods: This single-blind, randomized, controlled trial involved 44 PwMS (Expanded Disability Status Scale:1.5–8) and hand dexterity deficits. The experimental group (n = 23) received robot-assisted hand training; the control group (n = 21) received non-robotic hand training. Training protocols lasted for 5 weeks (50 min/session, 2 sessions/week). Before (T0), after (T1), and at 1 month follow-up (T2), a blinded rater evaluated patients using a comprehensive test battery. Primary outcome: Action Research Arm Test. Secondary outcomes: Nine Holes Peg Test; Fugl-Meyer Assessment Scale–upper extremity section; Motricity Index; Motor Activity Log; Multiple Sclerosis (MS) Quality of Life−54; Life Habits assessment—general short form and surface electromyography.Results: There were no significant between-group differences in primary and secondary outcomes. Electromyography showed relevant changes providing evidence increased activity in the extensor carpi at T1 and T2.Conclusion: The training effects on upper limb activity and function were comparable between the two groups. However, robot-assisted training demonstrated remarkable effects on upper limb use and muscle activity. https://clinicaltrials.gov NCT03561155.

Characterization of Upper Limb Impairments at Body Function, Activity, and Participation in Persons With Multiple Sclerosis by Behavioral and EMG Assessment: A Cross-Sectional Study

“…Accordingly, previous work by Pellegrino et al (16) concluded that both kinematic and electromyographic parameters might represent biomarkers that help clinicians in differentiating patients with different levels of UL motor impairment from healthy subjects (16). Surface EMG was reported to help investigate motor dysfunction as force control and fatigue in PwMS (17,18). Results are strengthened by the sEMG protocol used during a task of reaching while grasping an object.…”

“…In this observational cross-sectional study, we used data provided by a database created for a randomized controlled trial on hand dexterity robot-assisted rehabilitation by Gandolfi et al (18) (20); Modified Ashworth Scale score evaluated at the elbow, wrist, and fingers ≤2 (21); and NHPT score between 30 and 300 s (13). Exclusion criteria were the absence of relapses or relapse-related treatments in the 3 months before the study, and other neurological or orthopedic diseases interfering with UL function.…”

Upper limb rehabilitation interventions using virtual reality for people with multiple sclerosis: A systematic review

“…Current evidence suggests that rehabilitation can contribute to improving UL motor function in people with MS (Gandolfi et al, 2018;Gervasoni et al, 2019) however this evidence is limited due to UL rehabilitation interventions being historically understudied, despite the impact of UL impairment in people with MS (Kraft et al, 2014). One promising yet relatively new strategy of motor rehabilitation research is the use of Virtual Reality (VR).…”

Beyond therapists: Technology-aided physical MS rehabilitation delivery

“…Some studies tested the effects of arm robotics in MS population, 33–39 reporting positive effects on reaching spatio-temporal parameters and smoothness 33,40 or arm function 35,37 and hand muscle activity. 39 Furthermore, the additional use of functional electrical stimulation (FES) could improve motor learning by focusing on arm movement accuracy. 36 In conclusion, arm robotics, eventually combined with virtual reality or FES systems, is an option to deliver arm massed practice.…”