Effects of High-intensity Robot-assisted Hand Training on Upper Limb Recovery and Muscle Activity in Individuals With Multiple Sclerosis: A Randomized, Controlled, Single-Blinded Trial.

Marialuisa Gandolfi,Jessica Corradi,Maruo Camin,Elena Chemello,Stefano Mazzoleni,Eleonora Kirilova Dimitrova,Mirko Filippetti,Alberto Gajofatto,Leopold Saltuari,Nicola Valè,Elena Battini,Alessandro Picelli,Nicola Smania,Carola De Paoli,Andreas Waldner,Francesco Ferraro,Maria Donata Benedetti,Matteo Castelli

doi:10.3389/fneur.2018.00905

Abstract

Background : Integration of robotics and upper limb rehabilitation in people with multiple sclerosis (PwMS) has rarely been investigated.Objective: To compare the effects of robot-assisted hand training against non-robotic hand training on upper limb activity in PwMS. To compare the training effects on hand dexterity, muscle activity, and upper limb dysfunction as measured with the International Classification of Functioning.Methods: This single-blind, randomized, controlled trial involved 44 PwMS (Expanded Disability Status Scale:1.5–8) and hand dexterity deficits. The experimental group (n = 23) received robot-assisted hand training; the control group (n = 21) received non-robotic hand training. Training protocols lasted for 5 weeks (50 min/session, 2 sessions/week). Before (T0), after (T1), and at 1 month follow-up (T2), a blinded rater evaluated patients using a comprehensive test battery. Primary outcome: Action Research Arm Test. Secondary outcomes: Nine Holes Peg Test; Fugl-Meyer Assessment Scale–upper extremity section; Motricity Index; Motor Activity Log; Multiple Sclerosis (MS) Quality of Life−54; Life Habits assessment—general short form and surface electromyography.Results: There were no significant between-group differences in primary and secondary outcomes. Electromyography showed relevant changes providing evidence increased activity in the extensor carpi at T1 and T2.Conclusion: The training effects on upper limb activity and function were comparable between the two groups. However, robot-assisted training demonstrated remarkable effects on upper limb use and muscle activity. https://clinicaltrials.gov NCT03561155.

Highlights

Multiple sclerosis (MS) is the most common non-traumatic cause of neurologic disability in young adults worldwide [1]
The examiner was blinded to group assignment (Figure 3)
Cerebellar functions assessed with Expanded Disability Status Scale (EDSS) subitem were homogeneous between experimental group (EG) and control group (CG) and the median score was 1 corresponding to “Abnormal signs without disability.”

Summary

Introduction

Multiple sclerosis (MS) is the most common non-traumatic cause of neurologic disability in young adults worldwide [1]. Integration of robot-assisted devices in upper limb training programs has gained increasing interest for their capability to provide early, intensive, task-specific and multisensory stimulation especially in stroke patients [7]. Despite differences in sample characteristics and methodologies, the literature generally supports the benefits of upper limb robot-assisted training in people with MS. Two controlled trials on upper limb robot-assisted training in people with MS have used devices designed for rehabilitating the proximal upper limb (shoulder and elbow) [9, 10]. No studies to date have been performed using a robot-assisted device designed for the hand in people with MS. Integration of robotics and upper limb rehabilitation in people with multiple sclerosis (PwMS) has rarely been investigated

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Conclusion