NeuroRehabilitation - Volume 41, issue 1

Authors: Krebs, Hermano Igo

Article Type: Introduction

DOI: 10.3233/NRE-171451

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 1-3, 2017

Authors: Duret, Christophe | Mazzoleni, Stefano

Article Type: Research Article

Abstract: BACKGROUND: During the last two decades, extensive interaction between clinicians and engineers has led to the development of systems that stimulate neural plasticity to optimize motor recovery after neurological lesions. This has resulted in the expansion of the field of robotics for rehabilitation. Studies in patients with stroke-related upper-limb paresis have shown that robotic rehabilitation can improve motor capacity. However, few other applications have been evaluated (e.g. tremor, peripheral nerve injuries or other neurological diseases). PURPOSE: This paper presents an overview of the current use of upper limb robotic systems for neurorehabilitation, and highlights the rationale behind …their use for the assessment and treatment of common neurological disorders. CONCLUSIONS: Rehabilitation robots are little integrated in clinical practice, except after stroke. Although few studies have been carried out to evaluate their effectiveness, evidence from the neurosciences and indications from pilot studies suggests that upper limb robotic rehabilitation can be applied safely in various other neurological conditions. Rehabilitation robots provide an intensity, quality and dose of treatment that exceeds therapist-mediated rehabilitation. Moreover, the use of force fields, multi-sensory environments, feedback etc. renders such rehabilitation engaging and motivating. Future studies should evaluate the effectiveness of rehabilitation robots in neurological pathologies other than stroke. Show more

Keywords: Hemiparesis, motor learning, multiple sclerosis, neglect, neurorehabilitation, Parkinson disease, robotics, spinal cord injury, stroke

DOI: 10.3233/NRE-171452

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 5-15, 2017

Authors: Pizzamiglio, Sara | Desowska, Adela | Shojaii, Pegah | Taga, Myriam | Turner, Duncan L.

Article Type: Research Article

Abstract: BACKGROUND: Muscle co-contraction is a strategy of increasing movement accuracy and stability employed in dealing with force perturbation of movement. It is often seen in neuropathological populations. The direction of movement influences the pattern of co-contraction, but not all movements are easily achievable for populations with motor deficits. Manipulating the direction of the force instead, may be a promising rehabilitation protocol to train movement with use of a co-contraction reduction strategy. Force field learning paradigms provide a well described procedure to evoke and test muscle co-contraction. OBJECTIVE: The aim of this study was to test the muscle …co-contraction pattern in a wide range of arm muscles in different force-field directions utilising a robot-mediated force field learning paradigm of motor adaptation. METHOD: Forty-two participants volunteered to participate in a study utilising robot-mediated force field motor adaptation paradigm with a clockwise or counter-clockwise force field. Kinematics and surface electromyography (EMG) of eight arm muscles were measured. RESULTS: Both muscle activation and co-contraction was earlier and stronger in flexors in the clockwise condition and in extensors in the counter-clockwise condition. CONCLUSIONS: Manipulating the force field direction leads to changes in the pattern of muscle co-contraction. Show more

Keywords: Motor adaptation, force-field learning, EMG, co-contraction, rehabilitation

DOI: 10.3233/NRE-171453

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 17-29, 2017

Authors: Grosmaire, Anne-Gaëlle | Duret, Christophe

Article Type: Research Article

Abstract: BACKGROUND: Repetitive, active movement-based training promotes brain plasticity and motor recovery after stroke. Robotic therapy provides highly repetitive therapy that reduces motor impairment. However, the effect of assist-as-needed algorithms on patient participation and movement quality is not known. OBJECTIVE: To analyze patient participation and motor performance during highly repetitive assist-as-needed upper limb robotic therapy in a retrospective study. METHODS: Sixteen patients with sub-acute stroke carried out a 16-session upper limb robotic training program combined with usual care. The Fugl-Meyer Assessment (FMA) score was evaluated pre and post training. Robotic assistance parameters and Performance measures were …compared within and across sessions. RESULTS: Robotic assistance did not change within-session and decreased between sessions during the training program. Motor performance did not decrease within-session and improved between sessions. Velocity-related assistance parameters improved more quickly than accuracy-related parameters. CONCLUSIONS: An assist-as-needed-based upper limb robotic training provided intense and repetitive rehabilitation and promoted patient participation and motor performance, facilitating motor recovery. Show more

Keywords: Hemiparesis, assist-as-needed, motor performance, participation, robotic therapy

DOI: 10.3233/NRE-171454

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 31-39, 2017

Authors: Friel, Kathleen M. | Lee, Peter | Soles, Lindsey V. | Smorenburg, Ana R.P. | Kuo, Hsing-Ching | Gupta, Disha | Edwards, Dylan J.

Article Type: Research Article

Abstract: BACKGROUND: Robotic therapy can improve upper limb function in hemiparesis. Excitatory transcranial direct current stimulation (tDCS) can prime brain motor circuits before therapy. OBJECTIVE: We tested safety and efficacy of tDCS plus robotic therapy in an adult with unilateral spastic cerebral palsy (USCP). METHODS: In each of 36 sessions, anodal tDCS (2 mA, 20 min) was applied over the motor map of the affected hand. Immediately after tDCS, the participant completed robotic therapy, using the shoulder, elbow, and wrist (MIT Manus). The participant sat in a padded chair with affected arm abducted, forearm supported, and hand grasping …the robot handle. The participant controlled the robot arm with his affected arm to move a cursor from the center of a circle to each of eight targets (960 movements). Motor function was tested before, after, and six months after therapy with the Wolf Motor Function Test (WMFT) and Fugl-Meyer (FM). RESULTS: Reaching accuracy on the robot task improved significantly after therapy. The WMFT and FM improved clinically meaningful amounts after therapy. The motor map of the affected hand expanded after therapy. Improvements were maintained six months after therapy. CONCLUSIONS: Combined tDCS and robotics safely improved upper limb function in an adult with USCP. Show more

Keywords: Neuromodulation, neuroplasticity, rehabilitation

DOI: 10.3233/NRE-171455

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 41-50, 2017

Authors: Cortes, Mar | Medeiros, Ana Heloisa | Gandhi, Aasta | Lee, Peter | Krebs, Hermano Igo | Thickbroom, Gary | Edwards, Dylan

Article Type: Research Article

Abstract: BACKGROUND: Recovering hand function has important implications for improving independence of patients with tetraplegia after traumatic spinal cord injury (SCI). Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulation technique that has potential to improve motor function. OBJECTIVE: To investigate the effects of one session of 1 mA, 2 mA, and sham anodal tDCS (a-tDCS) in the upper extremity (hand) motor performance (grasp and lease) in patients with chronic cervical SCI. METHODS: Eleven participants with incomplete SCI were randomized to receive 20 minutes of 1 mA, 2 mA, or sham stimulation over the targeted motor cortex over three separated …sessions. Hand motor performance was measured by a hand robotic evaluation (kinematics) and the Box and Blocks (BB) test before and after the stimulation period. RESULTS: A significant improvement on the grasp mean to peak speed ratio (GMP) was observed in the 2 mA group (pre: 0.38±0.02; post: 0.43±0.03; mean±SEM; p  = 0.031). There was no statistically significant difference in BB test results, however the 2 mA intervention showed a positive trend for improvement. CONCLUSIONS: A single session of 2 mA of a-tDCS showed gains in hand motor function in patients with chronic SCI that were not observed in functional clinical scales. The use of robotic kinematics showed promising results in assessing small changes in motor performance. Further studies are necessary to determine whether tDCS can be an effective long-term rehabilitation strategy for individuals with SCI. Show more

Keywords: tDCS, hand robot, motor recovery, spinal cord injury

DOI: 10.3233/NRE-171456

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 51-59, 2017

Authors: Chang, Johanna L. | Lin, Regina Y. | Saul, Maira | Koch, Philip J. | Krebs, Hermano Igo | Volpe, Bruce T.

Article Type: Research Article

Abstract: BACKGROUND: Robotic driven treatment plans targeting isolated joints of the upper limb have improved the sensorimotor condition of patients with stroke. Similar intensive efforts to allay lower limb gait impairment have not been so successful. In patients with stroke, targeted robot assisted training of the ankle joint, in a seated position, has demonstrated significant alterations in ankle stiffness and foot-ankle orientation at foot strike which may provide a new treatment option for gait impairment. OBJECTIVE: To determine if isolated robot-assisted training of the ankle joint improves chronic hemiparetic gait in patients with stroke who are categorized according …to baseline gait impairment. METHODS: Patients with chronic stroke (>6mo) and hemiparetic gait (N = 29) received 18 sessions of isolated robot-assisted motor training of the ankle (3×/week for 6 weeks). All participants had stable clinical baseline scores across three admission measures, and no participant was receiving simultaneous outpatient rehabilitation. Baseline gait speed determined three impairment groups: high, >0.8 m/s; medium, 0.4–0.8 m/s; low, <0.4 m/s. Outcome measures included the Berg Balance Scale, the 6 Minute Walk Test, and the 10 Meter Walk Test, and were recorded upon admission, discharge, and 3 months following intervention. RESULTS: Three distinct and significant between-group patterns of recovery emerged for gait speed. The within-group analysis showed that the medium and high group exhibited significant improvements in gait speed and endurance upon discharge, that were maintained at 3-months. Gait speed improvements were clinically significant (>0.16 m/s) for the high function group across all gait speed and endurance measures at discharge and at 3 months. The moderate group also exhibited clinically significant improvements at follow-up on the 10 Meter Walk Test, fast pace (0.16 m/sec), and approached clinical significance for the 10 Meter Walk comfortable pace (0.12 m/sec). The low group had small but significant improvements, at discharge on two of the three gait measures, and these improvements were maintained at 3 months. For balance measures, the low and moderate impairment groups had significant improvements at discharge that were robust on follow-up measure. The high function group demonstrated no significant change in balance. CONCLUSIONS: Joint-specific robotic training of the paretic ankle provided the most benefit to individuals with moderate or mild gait speed impairments after stroke. Baseline gait speed function (low, moderate, high) was associated with three distinct recovery profiles. This suggests that severity-specific intervention may be critical to improving efficiency of stroke recovery. Show more

Keywords: Stroke, hemiparesis, robotic training, gait rehabilitation, physical therapy

DOI: 10.3233/NRE-171457

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 61-68, 2017

Authors: Michmizos, Konstantinos P. | Krebs, Hermano Igo

Article Type: Research Article

Abstract: BACKGROUND: Robot-aided sensorimotor therapy imposes highly repetitive tasks that can translate to substantial improvement when patients remain cognitively engaged into the clinical procedure, a goal that most children find hard to pursue. Knowing that the child’s brain is much more plastic than an adult’s, it is reasonable to expect that the clinical gains observed in the adult population during the last two decades would be followed up by even greater gains in children. Nonetheless, and despite the multitude of adult studies, in children we are just getting started: There is scarcity of pediatric robotic rehabilitation devices that are currently …available and the number of clinical studies that employ them is also very limited. PURPOSE: We have recently developed the MIT’s pedi-Anklebot, an adaptive habilitation robotic device that continuously motivates physically impaired children to do their best by tracking the child’s performance and modifying their therapy accordingly. The robot’s design is based on a multitude of studies we conducted focusing on the ankle sensorimotor control. In this paper, we briefly describe the device and the adaptive environment we built around the impaired children, present the initial clinical results and discuss how they could steer future trends in pediatric robotic therapy. CONCLUSIONS: The results support the potential for future interventions to account for the differences in the sensorimotor control of the targeted limbs and their functional use (rhythmic vs. discrete movements and mechanical impedance training) and explore how the new technological advancements such as the augmented reality would employ new knowledge from neuroscience. Show more

Keywords: Rehabilitation robotics, robot-aided therapy, robot-aided neurorehabilitation, pediatric, cerebral palsy, adaptive robotic therapy

DOI: 10.3233/NRE-171458

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 69-76, 2017

Authors: Hirano, Satoshi | Saitoh, Eiichi | Tanabe, Shigeo | Tanikawa, Hiroki | Sasaki, Shinya | Kato, Daisuke | Kagaya, Hitoshi | Itoh, Norihide | Konosu, Hitoshi

Article Type: Research Article

Abstract: BACKGROUND: In a patient with severe hemiplegia, the risk of the knee giving way is high during the early stage of gait exercise with an ankle-foot orthosis. However, use of a knee-ankle-foot orthosis has many problems such as large amount of assistance and compensatory motions. To resolve these problems, we have engaged in the development of the Gait Exercise Assist Robot (GEAR). OBJECTIVE: To evaluate the improvement efficiency of walk with GEAR in a stroke patient. METHODS: The subject was a 70-year-old man presented with left thalamus hemorrhage and right hemiplegia. The patient underwent exercise …with the GEAR 5 days a week, for 40 minutes per day. We evaluated the Functional Independence Measure score for walk (FIM-walk score) every week. The control group consisted of 15 patients aged 20–75 years with hemiplegia after primary stroke, who had equivalent walking ability with the subject at start. As the primary outcome, we defined improvement efficiency of FIM-walk, which was gain of FIM-walk divided the number of required weeks. RESULTS: Improvement efficiency of FIM-walk of the subject was 1.5, while that of control group was 0.48±3.2 (mean±SD). CONCLUSIONS: GEAR is potentially useful for gait exercise in hemiplegic patients. Show more

Keywords: Robotic therapy, gait training, stroke

DOI: 10.3233/NRE-171459

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 77-84, 2017

Authors: Tanabe, Shigeo | Koyama, Soichiro | Saitoh, Eiichi | Hirano, Satoshi | Yatsuya, Kanan | Tsunoda, Tetsuya | Katoh, Masaki | Gotoh, Takeshi | Furumoto, Ayako

Article Type: Research Article

Abstract: BACKGROUND: Patients with tetraplegia can achieve independent gait with lateral-type powered exoskeletons; it is unclear whether medial-type powered exoskeletons allow for this. OBJECTIVE: To investigate gait training with a medial-type powered exoskeleton wearable power-assist locomotor (WPAL) in an individual with incomplete cervical (C5) and complete thoracic (T12) spinal cord injury (SCI). METHODS: The 60-session program was investigated retrospectively using medical records. Upon completion, gait performance was examined using three-dimensional motion analyses and surface electromyography (EMG) of the upper limbs. RESULTS: The subject achieved independent gait with WPAL and a walker in 12 sessions. …He continuously extended his right elbow; his left elbow periodically flexed/extended. His pelvic inclination was larger than the trunk inclination during single-leg stance. EMG activity was increased in the left deltoid muscles during ipsilateral foot-contact. The right anterior and medial deltoid muscle EMG activity increased just after foot-off for each leg, as did the right biceps activity. Continuous activity was observed in the left triceps throughout the gait cycle; activity was unclear in the right triceps. CONCLUSIONS: These results suggest the importance of upper limb residual motor function, and may be useful in extending the range of clinical applications for robotic gait rehabilitation in patients with SCI. Show more

Keywords: Clinical feasibility, gait, robotic exoskeleton, spinal cord injury

DOI: 10.3233/NRE-171460

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 85-95, 2017