Pattern of improvement in upper limb pointing task kinematics after a 3-month training program with robotic assistance in stroke

Journal of NeuroEngineering and Rehabilitation, Oct 2017

When exploring changes in upper limb kinematics and motor impairment associated with motor recovery in subacute post stroke during intensive therapies involving robot-assisted training, it is not known whether trained joints improve before non-trained joints and whether target reaching capacity improves before movement accuracy. Twenty-two subacute stroke patients (mean delay post-stroke at program onset 63 ± 29 days, M2) underwent 50 ± 17 (mean ± SD) 45-min sessions of robot-assisted (InMotion™) shoulder/elbow training over 3 months, in addition to conventional occupational therapy. Monthly evaluations (M2 to M5) included Fugl-Meyer Assessment (FM), with subscores per joint, and four robot-based kinematic measures: mean target distance covered, mean velocity, direction accuracy (inverse of root mean square error from straight line) and movement smoothness (inverse of mean number of zero-crossings in the velocity profile). We assessed delays to reach statistically significant improvement for each outcome measure. At M5, all clinical and kinematic parameters had markedly improved: Fugl-Meyer, +65% (median); distance covered, +87%; mean velocity, +101%; accuracy, +134%; and smoothness, +96%. Delays to reach statistical significance were M3 for the shoulder/elbow Fugl-Meyer subscore (+43%), M4 for the hand (+80%) and M5 for the wrist (+133%) subscores. For kinematic parameters, delays to significant improvements were M3 for distance (+68%), velocity (+65%) and smoothness (+50%), and M5 for accuracy (+134%). An intensive rehabilitation program combining robot-assisted shoulder/elbow training and conventional occupational therapy was associated with improvement in shoulder and elbow movements first, which suggests focal behavior-related brain plasticity. Findings also suggested that recovery of movement quantity related parameters (range of motion, velocity and smoothness) might precede that of movement quality (accuracy). EudraCT 2016–005121-36 . Date of Registration: 2016–12-20. Date of enrolment of the first participant to the trial: 2009–11-24 (retrospective data).

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Pattern of improvement in upper limb pointing task kinematics after a 3-month training program with robotic assistance in stroke

Pila et al. Journal of NeuroEngineering and Rehabilitation Pattern of improvement in upper limb pointing task kinematics after a 3-month training program with robotic assistance in stroke Ophélie Pila 0 1 3 4 Christophe Duret 1 4 François-Xavier Laborne 2 Jean-Michel Gracies 0 3 Nicolas Bayle 0 3 Emilie Hutin 0 3 0 EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement (ARM), Université Paris-Est Créteil, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny , Créteil 94010 , France 1 Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation , 19 rue du Château, Boissise-Le-Roi 77310 , France 2 SAMU 91, Centre Hospitalier Sud Francilien , 116 Boulevard Jean Jaurès, Corbeil-Essonnes 91100 , France 3 EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement (ARM), Université Paris-Est Créteil, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny , Créteil 94010 , France 4 Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation , 19 rue du Château, Boissise-Le-Roi 77310 , France Background: When exploring changes in upper limb kinematics and motor impairment associated with motor recovery in subacute post stroke during intensive therapies involving robot-assisted training, it is not known whether trained joints improve before non-trained joints and whether target reaching capacity improves before movement accuracy. Methods: Twenty-two subacute stroke patients (mean delay post-stroke at program onset 63 ± 29 days, M2) underwent 50 ± 17 (mean ± SD) 45-min sessions of robot-assisted (InMotion™) shoulder/elbow training over 3 months, in addition to conventional occupational therapy. Monthly evaluations (M2 to M5) included Fugl-Meyer Assessment (FM), with subscores per joint, and four robot-based kinematic measures: mean target distance covered, mean velocity, direction accuracy (inverse of root mean square error from straight line) and movement smoothness (inverse of mean number of zero-crossings in the velocity profile). We assessed delays to reach statistically significant improvement for each outcome measure. Results: At M5, all clinical and kinematic parameters had markedly improved: Fugl-Meyer, +65% (median); distance covered, +87%; mean velocity, +101%; accuracy, +134%; and smoothness, +96%. Delays to reach statistical significance were M3 for the shoulder/elbow Fugl-Meyer subscore (+43%), M4 for the hand (+80%) and M5 for the wrist (+133%) subscores. For kinematic parameters, delays to significant improvements were M3 for distance (+68%), velocity (+65%) and smoothness (+50%), and M5 for accuracy (+134%). Conclusions: An intensive rehabilitation program combining robot-assisted shoulder/elbow training and conventional occupational therapy was associated with improvement in shoulder and elbow movements first, which suggests focal behavior-related brain plasticity. Findings also suggested that recovery of movement quantity related parameters (range of motion, velocity and smoothness) might precede that of movement quality (accuracy). Trial registration: EudraCT 2016-005121-36. Date of Registration: 2016-12-20. Date of enrolment of the first participant to the trial: 2009-11-24 (retrospective data). Hemiparesis; Subacute stroke; Prolonged robot-assisted training; High intensity; Repetitive active movements Background Following stroke, 70 to 90% of patients report residual motor impairment in their paretic upper limb, affecting daily activities and quality of life [ 1–5 ]. The recovery of motor function results in part from neural re-organization, which is facilitated by early onset of rehabilitation care [ 6 ] and high intensity of training programs [ 7, 8 ]. High intensity may relate to extended program durations, increased frequencies of rehabilitation sessions or to an increased number of specific movements or tasks achieved per session [ 9–11 ]. The use of robotic devices in spastic paresis helps deliver high dosages of physical treatment, based on high number repetition of goal-directed tasks in an interactive environment [ 12–17 ]. A number of controlled clinical trials have suggested positive effects of robot-assisted training programs, applied in complete or partial substitution of or in adjunction to conventional occupational therapy, on upper limb function in subacute and chronic stroke [ 12–17 ]. Overall, greater motor improvements were reported with robot-assisted training programs when compared with conventional therapy programs [ 12–16 ], except when a matched intensity level of exercise was used in manual therapy, which is unusual or difficult in conventional rehabilitation [ 17–19 ]. In addition to potentially enhancing motor improvement after stroke, robotic devices com (...truncated)


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Ophélie Pila, Christophe Duret, François-Xavier Laborne, Jean-Michel Gracies, Nicolas Bayle, Emilie Hutin. Pattern of improvement in upper limb pointing task kinematics after a 3-month training program with robotic assistance in stroke, Journal of NeuroEngineering and Rehabilitation, 2017, pp. 105, DOI: 10.1186/s12984-017-0315-1