Upper limb evaluation with robotic exoskeleton. Normative values for indices of accuracy, speed and smoothness

Merlo, Andrea; Longhi, Maria Serena; Giannotti, E.; Prati, P.; Giacobbi, M.; Ruscelli, E.; Am, Mancini; Ottaviani, Marco; Montanari, Luisa; Mazzoli, Davide

doi:10.3233/nre-130998

Cited by 49 publications

(67 citation statements)

References 18 publications

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“…There are some conflicting reports in the literature concerning the improvement in spasticity sustained by MV and Armeo-Power practiced alone [ 76 – 77 ]. Our data suggest that MV combined with robotic neurorehabilitation may improve spasticity in post-stroke patients, probably in keeping with the principles of associative plasticity [ 9 – 12 , 23 , 32 – 33 ]. In fact, MV allowed for boosting corticospinal excitability at both the cortical and spinal level (i.e., a clear modulation SICI and HMR) as compared to Armeo-Power delivered alone.…”

Section: Discussionsupporting

confidence: 70%

Is two better than one? Muscle vibration plus robotic rehabilitation to improve upper limb spasticity and function: A pilot randomized controlled trial

et al. 2017

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Even though robotic rehabilitation is very useful to improve motor function, there is no conclusive evidence on its role in reducing post-stroke spasticity. Focal muscle vibration (MV) is instead very useful to reduce segmental spasticity, with a consequent positive effect on motor function. Therefore, it could be possible to strengthen the effects of robotic rehabilitation by coupling MV. To this end, we designed a pilot randomized controlled trial (Clinical Trial NCT03110718) that included twenty patients suffering from unilateral post-stroke upper limb spasticity. Patients underwent 40 daily sessions of Armeo-Power training (1 hour/session, 5 sessions/week, for 8 weeks) with or without spastic antagonist MV. They were randomized into two groups of 10 individuals, which received (group-A) or not (group-B) MV. The intensity of MV, represented by the peak acceleration (a-peak), was calculated by the formula (2πf)2A, where f is the frequency of MV and A is the amplitude. Modified Ashworth Scale (MAS), short intracortical inhibition (SICI), and Hmax/Mmax ratio (HMR) were the primary outcomes measured before and after (immediately and 4 weeks later) the end of the treatment. In all patients of group-A, we observed a greater reduction of MAS (p = 0.007, d = 0.6) and HMR (p<0.001, d = 0.7), and a more evident increase of SICI (p<0.001, d = 0.7) up to 4 weeks after the end of the treatment, as compared to group-B. Likewise, group-A showed a greater function outcome of upper limb (Functional Independence Measure p = 0.1, d = 0.7; Fugl-Meyer Assessment of the Upper Extremity p = 0.007, d = 0.4) up to 4 weeks after the end of the treatment. A significant correlation was found between the degree of MAS reduction and SICI increase in the agonist spastic muscles (p = 0.004). Our data show that this combined rehabilitative approach could be a promising option in improving upper limb spasticity and motor function. We could hypothesize that the greater rehabilitative outcome improvement may depend on a reshape of corticospinal plasticity induced by a sort of associative plasticity between Armeo-Power and MV.

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Section: Discussionsupporting

confidence: 70%

Is two better than one? Muscle vibration plus robotic rehabilitation to improve upper limb spasticity and function: A pilot randomized controlled trial

et al. 2017

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“…We have recently developed a customized stand-alone software that increases the usefulness of a commercially available exoskeleton (Armeo®Spring, Hocoma AG, Switzerland), by providing a set of indices aimed at assessing accuracy, velocity and smoothness of UL motion along with the related reference values [ 30 ]. When used with stroke patients, this assessment can be carried out between 5 to 15 min, depending on the patient’s impairment level.…”

Section: Introductionmentioning

confidence: 99%

Instrumental indices for upper limb function assessment in stroke patients: a validation study

Longhi¹,

Merlo

Prati³

et al. 2016

J NeuroEngineering Rehabil

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BackgroundRobotic exoskeletons are increasingly being used in objective and quantitative assessment of upper limb (UL) movements. A set of instrumental indices computed during robot-assisted reaching tasks with the Armeo®Spring has been proven to assess UL functionality. The aim of this study was to test the construct validity of this indices-based UL assessment when used with patients who have had a stroke.MethodsForty-four 45- to 79-year-old stroke patients with a Wolf Motor Function Test ability score (WMFT-FAS) ranging from 10 to 75 and a Motricity Index (MI) ranging from 14 to 33 at shoulder and elbow were enrolled, thus covering a wide range of impairments. Residual UL function was assessed by both the WMFT-FAS and the WMFT-TIME, as well as by a set of 9 numerical indices assessing movement accuracy, velocity and smoothness computed from a 3D endpoint trajectory obtained during the “Vertical Capture” task of the Armeo®Spring device. To explore which variables better represented motor control deficits, the Mann-Whitney U Test was used to compare patients’ indices to those obtained from 25 healthy individuals. To explore the inner relationships between indices and construct validity in assessing accuracy, velocity and smoothness, a factor analysis was carried out. To verify the indices concurrent validity, they were compared to both WMFT-FAS and WMFT-TIME by the Spearman’s correlation coefficient.ResultsSeven indices of stroke subjects were significantly different from those of healthy controls, with effect sizes in the range 0.35–0.74. Factor analysis confirmed that specific subsets of indices belonged to the domains of accuracy, velocity and smoothness (discriminant validity). One accuracy index, both velocity indices and two smoothness indices were significantly correlated with WMFT-FAS and WMFT-TIME (|rho| = 0.31–0.50) (concurrent validity). One index for each of the assessed movement domains was proven to have construct validity (discriminant and concurrent) and was selected. Moreover, the indices were able to detect differences in accuracy, velocity and/or smoothness in patients with the same WMFT level.ConclusionsThe proposed index-based UL assessment can be used to integrate and support clinical evaluation of UL function in stroke patients.

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“…Previous studies have developed some ad-hoc assessment tools to extract outcome measures of patients' performance [8,9], often requiring additional time for patients and clinicians. Others have exploited the built-it technology to extract indexes of task precision, movement smoothness and velocity [10]. Only few assessment meth- ods were validated with functional scales [7,11].…”

Section: Introductionmentioning

confidence: 99%

Quantitative Evaluation of Performance during Robot-assisted Treatment

Peri¹,

Biffi

Maghini

et al. 2016

Methods Inf Med

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SummaryIntroduction: This article is part of the Focus Theme of Methods of Information in Medicine on "Methodologies, Models and Algorithms for Patients Rehabilitation". Objectives: The great potential of robots in extracting quantitative and meaningful data is not always exploited in clinical practice. The aim of the present work is to describe a simple parameter to assess the performance of subjects during upper limb robotic training exploiting data automatically recorded by the robot, with no additional effort for patients and clinicians.Methods: Fourteen children affected by cerebral palsy (CP) performed a training with Armeo ® Spring. Each session was evaluated with P, a simple parameter that depends on the overall performance recorded, and median and interquartile values were computed to perform a group analysis. Results: Median (interquartile) values of P significantly increased from 0.27 (0.21) at T 0 to 0.55 (0.27) at T 1 . This improvement was functionally validated by a significant increase of the Melbourne Assessment of Unilateral Upper Limb Function. Conclusions: The parameter described here was able to show variations in performance over time and enabled a quantitative evaluation of motion abilities in a way that is reliable with respect to a well-known clinical scale.

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Upper limb evaluation with robotic exoskeleton. Normative values for indices of accuracy, speed and smoothness

Cited by 49 publications

References 18 publications

Is two better than one? Muscle vibration plus robotic rehabilitation to improve upper limb spasticity and function: A pilot randomized controlled trial

Is two better than one? Muscle vibration plus robotic rehabilitation to improve upper limb spasticity and function: A pilot randomized controlled trial

Instrumental indices for upper limb function assessment in stroke patients: a validation study

Quantitative Evaluation of Performance during Robot-assisted Treatment

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