Abstract
Background: Technology-supported rehabilitation is emerging as a solution to support therapists in providing a high-intensity, repetitive and task-specific treatment, aimed at improving stroke recovery. End-effector robotic devices are known to positively affect the recovery of arm functions, however there is a lack of evidence regarding exoskeletons. This paper evaluates the impact of cerebral lesion load on the response to a validated robotic-assisted rehabilitation protocol.Methods: Fourteen hemiparetic patients were assessed in a within-subject design (age 66.9 ± 11.3 years; 10 men and 4 women). Patients, in post-acute phase, underwent 7 weeks of bilateral arm training assisted by an exoskeleton robot combined with a conventional treatment (consisting of simple physical activity together with occupational therapy). Clinical and neuroimaging evaluations were performed immediately before and after rehabilitation treatments. Fugl-Meyer (FM) and Motricity Index (MI) were selected to measure primary outcomes, i.e., motor function and strength. Functional independance measure (FIM) and Barthel Index were selected to measure secondary outcomes, i.e., daily living activities. Voxel-based lesion symptom mapping (VLSM) was used to determine the degree of cerebral lesions associated with motor recovery.Results: Robot-assisted rehabilitation was effective in improving upper limb motor function recovery, considering both primary and secondary outcomes. VLSM detected that lesion load in the superior region of the corona radiata, internal capsule and putamen were significantly associated with recovery of the upper limb as defined by the FM scores (p-level < 0.01).Conclusions: The probability of functional recovery from stroke by means of exoskeleton robotic rehabilitation relies on the integrity of specific subcortical regions involved in the primary motor pathway. This is consistent with previous evidence obtained with conventional neurorehabilitation approaches.
Highlights
Several systematic and meta-analytic reviews have confirmed that robotic-assisted devices elicit robust motor recovery in patients with stroke, mainly in relation to the upper limb intervention (Masiero et al, 2007; Bertani et al, 2017; Lo et al, 2017)
Exclusion criteria were (1) bilateral impairment; severe sensory deficits in the paretic upper limb; (2) pregnancy, epilepsy, aphasia, cognitive impairment (Mini Mental State Evaluation, MMSE < 24) or behavioral dysfunction that would influence the patient’s ability to comprehend or participate in the treatment; (3) botulinum toxin injections or other medication influencing the function of the upper-limb; (4) inability to provide informed consent and (5) and/or pacemakers or other metallic implants incompatible with the 3T MRI scanner
The median lesion volume related to stroke damages was of 44.6 [range: 7–146] cm3
Summary
Several systematic and meta-analytic reviews have confirmed that robotic-assisted devices elicit robust motor recovery in patients with stroke, mainly in relation to the upper limb intervention (Masiero et al, 2007; Bertani et al, 2017; Lo et al, 2017). The basic idea is to exploit proprioceptive inputs using passive, repetitive, interactive, high-intensive bilateral movement training, which has been demonstrated to enhance motor recovery in stroke patients (Stinear et al, 2008; Choo et al, 2015; Saleh et al, 2017; Gandolfi et al, 2018) This device has been widely validated (Colizzi et al, 2009; Dolce et al, 2009; Pignolo et al, 2012) with respect to conventional neurorehabilitation approaches, demonstrating high degree of upper limb recovery as assessed by the Fugl-Meyer (FM) scale (Fugl-Meyer et al, 1975). This paper evaluates the impact of cerebral lesion load on the response to a validated robotic-assisted rehabilitation protocol
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