Effects of Robot-Assisted Therapy for the Upper Limb After Stroke

Veerbeek, Janne M.; Langbroek-Amersfoort, Anneli C.; Wegen, Erwin E. H. van; Meskers, Carel G.M.; Kwakkel, Gert

doi:10.1177/1545968316666957

Cited by 483 publications

(432 citation statements)

References 97 publications

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“…Veerbeek et al [38] considered a large number of randomized controlled trials. They evaluated both the proximal and distal part of the upper limb, and showed results on the impact of robotic treatment with significant but small improvements in motor control (∼2 points Fugl‐Meyer Assessment for the arm) and muscle strength of the paretic arm, but a negative effect on muscle tone.…”

Section: Resultsmentioning

confidence: 99%

Exoskeleton and End‐Effector Robots for Upper and Lower Limbs Rehabilitation: Narrative Review

Molteni

Gasperini

Cannaviello

et al. 2018

PM&R

196

143

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Recovery of upper and lower limbs function is essential to reach independence in daily activities in patients with upper motor neuron syndrome (UMNS). Rehabilitation can provide a guide for motor recovery influencing the neurobiology of neuronal plasticity providing controlled, repetitive, and variable patterns. Increasing therapy dosage, intensity, number of repetition, execution of task‐oriented exercises, and combining top‐down and bottom‐up approaches can promote plasticity and functional recovery. Robotic exoskeletons for upper and lower limbs, based on the principle of motor learning, have been introduced in neurorehabilitation. In this narrative review, we provide an overview of literature published on exoskeleton devices for upper and lower limb rehabilitation in patients with UMNS; we summarized the available current research evidence and outlined the new challenges that neurorehabilitation and bioengineering will have to face in the upcoming years. Robotic treatment should be considered a rehabilitation tool useful to generate a more complex, controlled multisensory stimulation of the patient and useful to modify the plasticity of neural connections through the experience of movement. Efficacy and efficiency of robotic treatment should be defined starting from intensity, complexity, and specificity of the robotic exercise, that are related to human‐robot interaction in terms of motion, emotion, motivation, meaning of the task, feedback from the exoskeleton, and fine motion assistance. Duration of a single session, global period of the treatment, and the timing for beginning of robotic treatment are still open questions. There is the need to evaluate and individualize the treatment according to patient's characteristics. Robotic devices for upper and lower limbs open a window to define therapeutic modalities as possible beneficial drug, able to boost biological, neurobiological, and epigenetic changes in central nervous system. We need to implement large and innovative research programs to answer these issues in the near future.

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Section: Resultsmentioning

confidence: 99%

Exoskeleton and End‐Effector Robots for Upper and Lower Limbs Rehabilitation: Narrative Review

Molteni

Gasperini

Cannaviello

et al. 2018

PM&R

196

143

View full text Add to dashboard Cite

show abstract

“…The evidence for repetitive task-specific training is of low to moderate quality21 and the effects have been disappointingly small even when the number of repetitions has been greatly increased 8. It is difficult to tell whether this lack of effect is specific to task-specific training because in general the dose (in terms of hours of active training) has been quite low, whether delivered by a therapist21 or robotic device 22. There have been suggestions that chronic stroke patients might not tolerate more training than has been offered in these trials,8 but the study of McCabe et al 10 and now our own clinical experience undermine this view.…”

Section: Discussionmentioning

confidence: 99%

Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square programme

Ward¹,

Brander

Kelly

2019

J Neurol Neurosurg Psychiatry

253

243

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ObjectivePersistent difficulty in using the upper limb remains a major contributor to physical disability post-stroke. There is a nihilistic view about what clinically relevant changes are possible after the early post-stroke phase. The Queen Square Upper Limb Neurorehabilitation programme delivers high-quality, high-dose, high-intensity upper limb neurorehabilitation during a 3-week (90 hours) programme. Here, we report clinical changes made by the chronic stroke patients treated on the programme, factors that might predict responsiveness to therapy and the relationship between changes in impairment and activity.MethodsUpper limb impairment and activity were assessed on admission, discharge, 6 weeks and 6 months after treatment, with modified upper limb Fugl-Meyer (FM-UL, max-54), Action Research Arm Test (ARAT, max-57) and Chedoke Arm and Hand Activity Inventory (CAHAI, max-91). Patient-reported outcome measures were recorded with the Arm Activity Measure (ArmA) parts A (0–32) and B (0–52), where lower scores are better.Results224 patients (median time post-stroke 18 months) completed the 6-month programme. Median scores on admission were as follows: FM-UL = 26 (IQR 16–37), ARAT=18 (IQR 7–33), CAHAI=40 (28-55), ArmA-A=8 (IQR 4.5–12) and ArmA-B=38 (IQR 24–46). The median scores 6 months after the programme were as follows: FM-UL=37 (IQR 24–48), ARAT=27 (IQR 12–45), CAHAI=52 (IQR 35–77), ArmA-A=3 (IQR 1–6.5) and ArmA-B=19 (IQR 8.5–32). We found no predictors of treatment response beyond admission scores.ConclusionWith intensive upper limb rehabilitation, chronic stroke patients can change by clinically important differences in measures of impairment and activity. Crucially, clinical gains continued during the 6-month follow-up period.

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“…Treadmill-based robotics was also developed leading to improvement of walking after stroke, but without change in speed and endurance. Current clinical studies explore safety and efficiency of exoskeletons for gait in subacute and chronic stroke, with more convincing results in the sub-acute phase [40,41].…”

Section: Outcome Of Rehabilitationmentioning

confidence: 99%