Rehabilitation and Plasticity

Luft, Andreas R.

doi:10.1159/000348879

Cited by 8 publications

(8 citation statements)

References 36 publications

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“…Previous studies on chronic stroke patients showed a significant decrease in shoulder and elbow motor impairment after the robot-assisted treatment [32,33] and different systematic reviews have explored the effects of intensive therapy on functional recovery [34,35], even if a consensus on this issue has not yet been reached, in particular as regards the effects on ADLs. Our previous experience on chronic stroke patients demonstrated that intensive robotic training can improve upper limb functional activity in terms of ROM and FM [36-38].…”

Section: Discussionmentioning

confidence: 99%

Effects of upper limb robot-assisted therapy on motor recovery in subacute stroke patients

Sale

Franceschini

Mazzoleni

et al. 2014

J NeuroEngineering Rehabil

129

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Background and purposeThere is little evidence available on the use of robot-assisted therapy in subacute stroke patients. A randomized controlled trial was carried out to evaluate the short-time efficacy of intensive robot-assisted therapy compared to usual physical therapy performed in the early phase after stroke onset.MethodsFifty-three subacute stroke patients at their first-ever stroke were enrolled 30 ± 7 days after the acute event and randomized into two groups, both exposed to standard therapy. Additional 30 sessions of robot-assisted therapy were provided to the Experimental Group. Additional 30 sessions of usual therapy were provided to the Control Group.The following impairment evaluations were performed at the beginning (T0), after 15 sessions (T1), and at the end of the treatment (T2): Fugl-Meyer Assessment Scale (FM), Modified Ashworth Scale-Shoulder (MAS-S), Modified Ashworth Scale-Elbow (MAS-E), Total Passive Range of Motion-Shoulder/Elbow (pROM), and Motricity Index (MI).ResultsEvidence of significant improvements in MAS-S (p = 0.004), MAS-E (p = 0.018) and pROM (p < 0.0001) was found in the Experimental Group. Significant improvement was demonstrated in both Experimental and Control Group in FM (EG: p < 0.0001, CG: p < 0.0001) and MI (EG: p < 0.0001, CG: p < 0.0001), with an higher improvement in the Experimental Group.ConclusionsRobot-assisted upper limb rehabilitation treatment can contribute to increasing motor recovery in subacute stroke patients. Focusing on the early phase of stroke recovery has a high potential impact in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Effects of upper limb robot-assisted therapy on motor recovery in subacute stroke patients

Sale

Franceschini

Mazzoleni

et al. 2014

J NeuroEngineering Rehabil

129

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“…Second, we aimed to investigate the functional correlates of language rehabilitation. We predicted that language therapy should be able to address brain plasticity, 32 promoting an early shift from RH to LH language-related areas in rehabilitated patients. Hence, early recruitment of LH perilesional areas would be the correlate of language improvement in early treated patients.…”

Section: Strokementioning

confidence: 99%

Early Aphasia Rehabilitation Is Associated With Functional Reactivation of the Left Inferior Frontal Gyrus

Mattioli

Ambrosi

Mascaro

et al. 2014

Stroke

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A n important issue for language rehabilitation after stroke is the relationship between the effects of therapeutic interventions and the functional changes observed in brain language-related areas. Most studies focused on the spontaneous recovery of language, [1][2][3][4][5][6][7] but only a few, often single case descriptions, focused on patients submitted to language rehabilitation. [8][9][10][11][12][13] All of these were conducted on chronic patients. The rate of complete spontaneous (ie, without language therapy) aphasia recovery poststroke has been estimated at ≈33% in the first month, 43% after 4 months, and 50% 12 months later.14 However, the concept of spontaneous recovery of language may not be appropriate (as human beings are extensively exposed to language). The term language therapy commonly relates to formal interventions provided by speech therapists aimed at improving different language abilities with specific exercises.Evidence supports the use of language rehabilitation in stroke, particularly if intensively administered for short courses in chronic aphasics. 15,16 In a pilot study, Godecke et al 17 found that daily aphasia therapy in early stroke, that is, mean 3 days poststroke (dps), resulted in improved communication outcomes in moderate to severe aphasia. Brain plasticity induced by language training has not been extensively investigated to date. Several studies, conducted in chronic patients, suggested that functional correlates of aphasia recovery could be either the activation of predominantly left hemisphere (LH) language-related areas [18][19][20][21][22] or of the homologous right hemisphere (RH) areas, 2,23-25 but often the authors do not clarify whether patients were formally treated and to what extent, or not. Saur et al 4 suggest that in the postacute stages of recovery (2 weeks poststroke), the LH areas would be reduced in activation, whereas after months Background and Purpose-Early poststroke aphasia rehabilitation effects and their functional MRI (fMRI) correlates were investigated in a pilot, controlled longitudinal study. Methods-Twelve patients with mild/moderate aphasia (8 Broca, 3 anomic, and 1 Wernicke) were randomly assigned to daily language rehabilitation for 2 weeks (starting 2.2 [mean] days poststroke) or no rehabilitation. The Aachen Aphasia Test and fMRI recorded during an auditory comprehension task were performed at 3 time intervals: mean 2.2 (T1), 16.2 (T2), and 190 (T3) days poststroke. Results-Groups did not differ in terms of age, education, aphasia severity, lesions volume, baseline fMRI activations, and in task performance during fMRI across examinations. Rehabilitated patients significantly improved in naming and written language tasks (P<0.05) compared with no rehabilitation group both at T2 and T3. Functional activity at T1 was reduced in language-related cortical areas (right and left inferior frontal gyrus and middle temporal gyrus, right inferior parietal lobule and superior temporal gyrus) in patients compared with controls. T2 and T3 follow-ups r...

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“…Some other studies also suggested that training devices which can provide rewarding schemes in a gaming environment had the ability to enhance the motivation of patients [ 44 , 45 ]. However, how to optimally apply motivational therapy into the rehabilitation to achieve better training outcomes is still unclear and need to be further investigated [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Translation of robot-assisted rehabilitation to clinical service: a comparison of the rehabilitation effectiveness of EMG-driven robot hand assisted upper limb training in practical clinical service and in clinical trial with laboratory configuration for chronic stroke

et al. 2018

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BackgroundRehabilitation robots can provide intensive physical training after stroke. However, variations of the rehabilitation effects in translation from well-controlled research studies to clinical services have not been well evaluated yet. This study aims to compare the rehabilitation effects of the upper limb training by an electromyography (EMG)-driven robotic hand achieved in a well-controlled research environment and in a practical clinical service.MethodsIt was a non-randomized controlled trial, and thirty-two participants with chronic stroke were recruited either in the clinical service (n = 16, clinic group), or in the research setting (n = 16, lab group). Each participant received 20-session EMG-driven robotic hand assisted upper limb training. The training frequency (4 sessions/week) and the pace in a session were fixed for the lab group, while they were flexible (1–3 sessions/week) and adaptive for the clinic group. The training effects were evaluated before and after the treatment with clinical scores of the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), Functional Independence Measure (FIM), and Modified Ashworth Scale (MAS).ResultsSignificant improvements in the FMA full score, shoulder/elbow and wrist/hand (P < 0.001), ARAT (P < 0.001), and MAS elbow (P < 0.05) were observed after the training for both groups. Significant improvements in the FIM (P < 0.05), MAS wrist (P < 0.001) and MAS hand (P < 0.05) were only obtained after the training in the clinic group. Compared with the lab group, higher FIM improvement in the clinic group was observed (P < 0.05).ConclusionsThe functional improvements after the robotic hand training in the clinical service were comparable to the effectiveness achieved in the research setting, through flexible training schedules even with a lower training frequency every week. Higher independence in the daily living and a more effective release in muscle tones were achieved in the clinic group than the lab group.

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Rehabilitation and Plasticity

Cited by 8 publications

References 36 publications

Effects of upper limb robot-assisted therapy on motor recovery in subacute stroke patients

Effects of upper limb robot-assisted therapy on motor recovery in subacute stroke patients

Early Aphasia Rehabilitation Is Associated With Functional Reactivation of the Left Inferior Frontal Gyrus

Translation of robot-assisted rehabilitation to clinical service: a comparison of the rehabilitation effectiveness of EMG-driven robot hand assisted upper limb training in practical clinical service and in clinical trial with laboratory configuration for chronic stroke

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