Valè N1, Gandolfi M1, Dimitrova E1, Mazzoleni S2, Battini E2, Zatezalo V1, Battistuzzi E1, Gravina M3, Santamato A3, Picelli A1, Smania N1
1University of Verona, Verona, Italy, 2The Biorobotics Institute, Scuola Superiore Sant'Anna di Pisa, Pisa, Italy, 3Univeristy of Foggia, Physical Medicine and Rehabilitation Section, OORR Hospital, Foggia, Italy
Background: Robotic technologies for the upper limb (UL) rehabilitation in stroke patients is developing rapidly. To date, evidence of the effect of robotic training combined with OnabotulinumtoxinA focal treatment for spasticity is limited.
Purpose: To compare the effects of high-intensity robot-assisted UL training against conventional rehabilitation on functional recovery and spasticity in chronic stroke patients with UL spasticity.
Methods: This single-blind, randomized, controlled trial involved 24 chronic stroke outpatients (age mean: 57 yrs; range: 22-77). The experimental group (n = 11) received high-intensity robot-assisted UL training using the Armotion/Motore (Reha Technology AG,Olten,Switzerland). The control group (n = 13) received conventional rehabilitation. Treatment lasted ten 45-minute sessions, twice per week. All patients have been treated with Botulinum Toxin injection in the UL.Before (T0), after treatment (T1), and at 1-month post-treatment (T2), patients were evaluated by a blinded rater. Primary outcome: Fugl-Meyer Assessment Motor Scale (FMA). Secondary outcome: Action Research Arm Test (ARAT), Modified Ashworth Scale (MAS), Medical Research Council Scale (MRC) and surface Electromyography (sEMG). sEMG was performed on 7 UL muscles of the paretic side (deltoid anterior/posterior, biceps/triceps brachii, grand pectoral, extensor/flexor radialis carpi) during the functional task: “Hand to mouth” (ARAT sub-test). 14 healthy age-matched controls underwent one session of sEMG acquisition to collect normative data. The sEMG signals were filtered and processed by using the approximated generalized likelihood-ratio algorithm to detect the muscle activity. The onset and offset of muscle activity were analyzed as the percentage of the movement cycle.
Results: Preliminary analysis in 17 patients showed no significant between-group differences on primary outcome. The EG showed greater improvements than the CG on the MRC for elbow flexion (p .05). Significant within-group effects were noted on the FMA in both groups (p .05). sEMG showed improvements on proximal muscles activity pattern in favor of the EG.
Conclusion(s): Ahigh-intensity robot-assisted UL training combined with botulinum toxin injection can promote UL functional recovery in chronic stroke patients with UL spasticity.
Implications: The sEMG analysis may contribute to better understand the mechanism underlying UL recovery, which is crucial to identify effective strategies for UL rehabilitation
Keywords: Neurorehabilitation, High-intensity training, Movement analysis
Funding acknowledgements: N/A
Purpose: To compare the effects of high-intensity robot-assisted UL training against conventional rehabilitation on functional recovery and spasticity in chronic stroke patients with UL spasticity.
Methods: This single-blind, randomized, controlled trial involved 24 chronic stroke outpatients (age mean: 57 yrs; range: 22-77). The experimental group (n = 11) received high-intensity robot-assisted UL training using the Armotion/Motore (Reha Technology AG,Olten,Switzerland). The control group (n = 13) received conventional rehabilitation. Treatment lasted ten 45-minute sessions, twice per week. All patients have been treated with Botulinum Toxin injection in the UL.Before (T0), after treatment (T1), and at 1-month post-treatment (T2), patients were evaluated by a blinded rater. Primary outcome: Fugl-Meyer Assessment Motor Scale (FMA). Secondary outcome: Action Research Arm Test (ARAT), Modified Ashworth Scale (MAS), Medical Research Council Scale (MRC) and surface Electromyography (sEMG). sEMG was performed on 7 UL muscles of the paretic side (deltoid anterior/posterior, biceps/triceps brachii, grand pectoral, extensor/flexor radialis carpi) during the functional task: “Hand to mouth” (ARAT sub-test). 14 healthy age-matched controls underwent one session of sEMG acquisition to collect normative data. The sEMG signals were filtered and processed by using the approximated generalized likelihood-ratio algorithm to detect the muscle activity. The onset and offset of muscle activity were analyzed as the percentage of the movement cycle.
Results: Preliminary analysis in 17 patients showed no significant between-group differences on primary outcome. The EG showed greater improvements than the CG on the MRC for elbow flexion (p .05). Significant within-group effects were noted on the FMA in both groups (p .05). sEMG showed improvements on proximal muscles activity pattern in favor of the EG.
Conclusion(s): Ahigh-intensity robot-assisted UL training combined with botulinum toxin injection can promote UL functional recovery in chronic stroke patients with UL spasticity.
Implications: The sEMG analysis may contribute to better understand the mechanism underlying UL recovery, which is crucial to identify effective strategies for UL rehabilitation
Keywords: Neurorehabilitation, High-intensity training, Movement analysis
Funding acknowledgements: N/A
Topic: Neurology: stroke; Robotics & technology; Human movement analysis
Ethics approval required: Yes
Institution: Azienda Ospedaliera universitaria Integrata Verona
Ethics committee: Ethic committee
Ethics number: CE 2366
All authors, affiliations and abstracts have been published as submitted.
