Comparative Assessment of Robotic versus Classical Physical Therapy Using Muscle Strength and Ranges of Motion Testing in Neurological Diseases.

Zoltán Zsigmond Major,Calin Vaida,Paul Tucan,Ionut Ulinici,Bogdan Gherman,Alin Burz,Iosif Birlescu,Kinga Andrea Major,Gábor Simori,Doina Pisla,Alexandru Banica,Raul Craciunaș,Emanuela Brusturean,Giuseppe Carbone,Nicoleta Pop

doi:10.3390/jpm11100953

Abstract

The use of robotic systems in physical rehabilitation protocols has become increasingly attractive and has been given more focus in the last decade as a result of the high prevalence of motor deficits in the population, which is linked to an overburdened healthcare system. In accordance with current trends, three robotic devices have been designed, called ParReEx Elbow, ParReEx Wrist, and ASPIRE, which were designed to improve upper-limb medical recovery (shoulder, elbow, forearm, and wrist). The three automated systems were tested in a hospital setting with 23 patients (12 men and 11 women) suffering from motor deficits caused by various neurological diseases such as stroke, Parkinson’s disease, and amyotrophic lateral sclerosis (ALS). The patients were divided into three groups based on their pathology (vascular, extrapyramidal, and neuromuscular). Objective clinical measures, such as the Medical Research Council (MRC) scale, goniometry, and dynamometry, were used to compare pre- and post-rehabilitation assessments for both robotic-aided and manual physical rehabilitation therapy. The results of these tests showed that, with the exception of a few minor differences in muscular strength recovery, the robotic-assisted rehabilitation methods performed equally as well as the manual techniques, though only minor improvements were validated during short-term rehabilitation. The greatest achievements were obtained in the goniometric analysis where some rehabilitation amplitudes increased by over 40% in the vascular group, but the same analysis returned regressions in the neuromuscular group. The MRC scale analysis returned no significant differences, with most regressions occurring in the neuromuscular group. The dynamometric analysis mostly returned improvements, but the highest value evolution was 19.07%, which also in the vascular group. While the results were encouraging, more research is needed with a larger sample size and a longer study period in order to provide more information regarding the efficacy of both rehabilitation methods in neurological illnesses.

Highlights

In neurological diseases, motor recovery is often deficient, with many patients experiencing long term impairments that have a negative effect on their quality of life and their capability of performing daily living activities
Some slight regressions in shoulder abduction were recorded in the Vascular group, and shoulder flexion and radio-carpal flexion regressions were demonstrated in the neuromuscular group
This initial exploratory study conducted on a group or patients with different neuromotor diseases comparatively assessed the use of robotic and manual physical therapy for rehabilitation

Summary

Introduction

Motor recovery is often deficient, with many patients experiencing long term impairments that have a negative effect on their quality of life and their capability of performing daily living activities. Physical therapy consists of specific exercises that have been developed to reestablish the functionality of the affected segment of the motor system and acts as an adjuvant to medical treatment. These movements can be taken over by automated systems [1] and robots, optimizing the frequency and time allocated to each exercise cycle, with the physical therapist only needing to configure the device with a personalized treatment protocol [2]. The results of the study revealed a higher reduction in motor impairment and enhancements in paretic upper-limb function in the case of robotic rehabilitation due to extended amount of time that the patient spent in rehabilitation

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