RESUMEN
BACKGROUND: Although robotics assisted rehabilitation has proven to be effective in stroke rehabilitation, a limited functional improvements in Activities of Daily Life has been also observed after the administration of robotic training. To this aim in this study we compare the efficacy in terms of both clinical and functional outcomes of a robotic training performed with a multi-joint functional exoskeleton in goal-oriented exercises compared to a conventional physical therapy program, equally matched in terms of intensity and time. As a secondary goal of the study, it was assessed the capability of kinesiologic measurements-extracted by the exoskeleton robotic system-of predicting the rehabilitation outcomes using a set of robotic biomarkers collected at the baseline. METHODS: A parallel-group randomized clinical trial was conducted within a group of 26 chronic post-stroke patients. Patients were randomly assigned to two groups receiving robotic or manual therapy. The primary outcome was the change in score on the upper extremity section of the Fugl-Meyer Assessment (FMA) scale. As secondary outcome a specifically designed bimanual functional scale, Bimanual Activity Test (BAT), was used for upper limb functional evaluation. Two robotic performance indices were extracted with the purpose of monitoring the recovery process and investigating the interrelationship between pre-treatment robotic biomarkers and post-treatment clinical improvement in the robotic group. RESULTS: A significant clinical and functional improvements in both groups (p < 0.01) was reported. More in detail a significantly higher improvement of the robotic group was observed in the proximal portion of the FMA (p < 0.05) and in the reduction of time needed for accomplishing the tasks of the BAT (p < 0.01). The multilinear-regression analysis pointed out a significant correlation between robotic biomarkers at the baseline and change in FMA score (R2 = 0.91, p < 0.05), suggesting their potential ability of predicting clinical outcomes. CONCLUSION: Exoskeleton-based robotic upper limb treatment might lead to better functional outcomes, if compared to manual physical therapy. The extracted robotic performance could represent predictive indices of the recovery of the upper limb. These results are promising for their potential exploitation in implementing personalized robotic therapy. Clinical Trial Registration clinicaltrials.gov, NCT03319992 Unique Protocol ID: RH-UL-LEXOS-10. Registered 20.10.2017, https://clinicaltrials.gov/ct2/show/NCT03319992.
Asunto(s)
Dispositivo Exoesqueleto , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Modalidades de Fisioterapia , Recuperación de la Función , Rehabilitación de Accidente Cerebrovascular/métodos , Resultado del Tratamiento , Extremidad SuperiorRESUMEN
The use of robotic rehabilitation in orthopaedics has been briefly explored. Despite its possible advantages, the use of computer-assisted physiotherapy of patients with musculoskeletal injuries has received little attention. In this paper, we detailed the development and evaluation of a robotic-assisted rehabilitation system as a new methodology of assisted physiotherapy in orthopaedics. The proposal consists of an enhanced end-effector haptic interface mounted in a passive mechanism for allowing patients to perform upper-limb exercising and integrates virtual reality games conceived explicitly for assisting the treatment of the forearm after injuries at the wrist or elbow joints. The present methodology represents a new approach to assisted physiotherapy for strength and motion recovery of wrist pronation/supination and elbow flexion-extension movements. We design specific game scenarios enriched by proprioceptive and haptic force feedback in three training modes: passive, active, and assisted exercising. The system allows the therapist to tailor the difficulty level on the observed motion capacity of the patients and the kinesiology measurements provided by the system itself. We evaluated the system through the analysis of the muscular activity of two healthy subjects, showing that the system can assign significant working loads during typical physiotherapy treatment profiles. Subsequently, a group of ten patients undergoing manual orthopaedic rehabilitation of the forearm tested the system, under similar conditions at variable intensities. Patients tolerated changes in difficulty through the tests, and they expressed a favourable opinion of the system through the administered questionnaires, which indicates that the system was well accepted and that the proposed methodology was feasible for the case study for subsequently controlled trials. Finally, a predictive model of the performance score in the form of a linear combination of kinesiology observations was implemented in function of difficult training parameters, as a way of systematically individualising the training during the therapy, for subsequent studies.
Asunto(s)
Articulación del Codo/fisiología , Ortopedia/métodos , Modalidades de Fisioterapia/instrumentación , Robótica , Realidad Virtual , Articulación de la Muñeca/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Calibración , Computadores , Articulación del Codo/fisiopatología , Diseño de Equipo , Ejercicio Físico , Retroalimentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Análisis de Componente Principal , Estrés Mecánico , Rehabilitación de Accidente Cerebrovascular , Extremidad Superior/fisiopatología , Interfaz Usuario-Computador , Articulación de la Muñeca/fisiopatología , Adulto JovenRESUMEN
We describe a robotic and virtual reality system for the rehabilitation of the forearm. It consists of a robotic arm and VR scenarios with a dynamic model of the human upper limb. The system allows to assign specific tasks to perform within the virtual environments. The system simulates the actions of the patient limb and allows exhaustive exercising and motor control, giving visuomotor and haptic feedback and trajectory positioning guidance. The system aids to evaluate the mobility condition of the patient, to personalize the difficult level of the therapy and provides kinematic measures of the patient evolution. The patients recruitment phase has already started for clinical pilot studies.
Asunto(s)
Traumatismos del Brazo/rehabilitación , Antebrazo , Robótica , Terapia Asistida por Computador/instrumentación , Interfaz Usuario-Computador , Humanos , Procesamiento de Señales Asistido por ComputadorRESUMEN
The distinguishing features of active exoskeletons are the capability of guiding arm movement at the level of the full kinematic chain of the human arm, and training full 3D spatial movements. We have specifically developed a PD sliding mode control for upper limb rehabilitation with gain scheduling for providing "assistance as needed", according to the force capability of the patient, and an automatic measurement of the impaired arm joint torques, to evaluate the hypertonia associated to the movement during the execution of the training exercise. Two different training tasks in Virtual Reality were devised, that make use of the above control, and allow to make a performance based evaluation of patient's motor status. The PERCRO L-Exos (Light-Exoskeleton) was used to evaluate the proposed algorithms and training exercises in two clinical case studies of patients with chronic stroke, that performed 6 weeks of robotic assisted training. Clinical evaluation (Fugl-Meyer Scale, Modified Ashworth Scale, Bimanual Activity Test) was conducted before and after treatment and compared to the scores and the quantitative indices, such as task time, position/joint error and resistance torques, associated to the training exercises.