Exoskeleton-Robot Assisted Therapy in Stroke Patients: A Lesion Mapping Study

Abstract

Background: Technology-supported rehabilitation is emerging as a solution to support therapists in providing a high-intensity, repetitive and task-specific treatment, aimed at improving stroke recovery. End-effector robotic devices are known to positively affect the recovery of arm functions, however there is a lack of evidence regarding exoskeletons. This paper evaluates the impact of cerebral lesion load on the response to a validated robotic-assisted rehabilitation protocol.Methods: Fourteen hemiparetic patients were assessed in a within-subject design (age 66.9 ± 11.3 years; 10 men and 4 women). Patients, in post-acute phase, underwent 7 weeks of bilateral arm training assisted by an exoskeleton robot combined with a conventional treatment (consisting of simple physical activity together with occupational therapy). Clinical and neuroimaging evaluations were performed immediately before and after rehabilitation treatments. Fugl-Meyer (FM) and Motricity Index (MI) were selected to measure primary outcomes, i.e., motor function and strength. Functional independance measure (FIM) and Barthel Index were selected to measure secondary outcomes, i.e., daily living activities. Voxel-based lesion symptom mapping (VLSM) was used to determine the degree of cerebral lesions associated with motor recovery.Results: Robot-assisted rehabilitation was effective in improving upper limb motor function recovery, considering both primary and secondary outcomes. VLSM detected that lesion load in the superior region of the corona radiata, internal capsule and putamen were significantly associated with recovery of the upper limb as defined by the FM scores (p-level < 0.01).Conclusions: The probability of functional recovery from stroke by means of exoskeleton robotic rehabilitation relies on the integrity of specific subcortical regions involved in the primary motor pathway. This is consistent with previous evidence obtained with conventional neurorehabilitation approaches.

Perspectives and Challenges in Robotic Neurorehabilitation

“…Then, many of the neurorehabilitation studies that employed emerging robotic solutions did not account for a complete characterization of brain activity. Some studies exist [166][167][168], but further efforts are required [166] to characterize the neural basis of the sensorimotor function recovery driven by novel robotic devices. An unmet interest is understanding how the structural and functional properties of the brain are sculpted by the rehabilitation program.…”

Usability Assessment of a Cable-Driven Exoskeletal Robot for Hand Rehabilitation

“…Robot-assisted rehabilitation has become increasingly popular in recent decades, and there are more and more therapy concepts that attributed to various novel rehabilitation robots (Shields et al, 1997; DiCicco et al, 2004; Wege and Hommel, 2005; Hasegawa et al, 2008; Chiri et al, 2009; Tadano et al, 2010; Brokaw et al, 2011; In et al, 2011; Kadowaki et al, 2011; Ueki et al, 2012; Villafañe et al, 2017; Cerasa et al, 2018; Jakob et al, 2018; Mazzoleni et al, 2018; Pila et al, 2018). In robot-assisted rehabilitation, patients can receive standardized and repetitive training controlled by robot actuators (Takahashi et al, 2005; Chang and Kim, 2013).…”

Data on a new neurorehabilitation approach targeting functional recovery in stroke patients

“…This device has been widely validated (Colizzi et al., 2009; Dolce et al., 2009; Pignolo et al., 2012) with respect to conventional neurorehabilitation approaches. In agreement with previously validated version [6,[11], [12], [13]], the ARAMIS protocol for rehabilitation included 60-min sessions over periods not exceeding 7 weeks. Copernicus is a system for the correct load balancing aimed at obtaining an early start of locomotion (http://www.rehalife.it/en/products). The patient wears a pair of insoles in his or her shoes equipped with piezoresistive sensors that detect the support of the foot and transfer the information via Wi-Fi to a controller with a monitor (tablet) that is visual feedback for the patient when executing the various rehabilitation exercises.…”

“…Following previously validated protocol [6], we performed a double-blind randomized controlled trial divided into 5 principal stages. The first stage was based on the recruitment of the patients for the study (see inclusion criteria reported above).…”