Abstract
This single arm pre-post study aimed at evaluating the acute effects induced by a single session of robot-assisted passive hand mobilization on local perfusion and upper limb (UL) function in poststroke hemiparetic participants. Twenty-three patients with subacute or chronic stroke received 20 min passive mobilization of the paretic hand with robotic assistance. Near-infrared spectroscopy (NIRS) was used to detect changes in forearm tissue perfusion. Muscle tone of the paretic UL was assessed by the Modified Ashworth Scale (MAS). Symptoms concerning UL heaviness, joint stiffness, and pain were evaluated as secondary outcomes by self-reporting. Significant (p = 0.014) improvements were found in forearm perfusion when all fingers were mobilized simultaneously. After the intervention, MAS scores decreased globally, being the changes statistically significant for the wrist (from 1.6 ± 1.0 to 1.1 ± 1.0; p = 0.001) and fingers (from 1.2 ± 1.1 to 0.7 ± 0.9; p = 0.004). Subjects reported decreased UL heaviness and stiffness after treatment, especially for the hand, as well as diminished pain when present. This study supports novel evidence that hand robotic assistance promotes local UL circulation changes, may help in the management of spasticity, and acutely alleviates reported symptoms of heaviness, stiffness, and pain in subjects with poststroke hemiparesis. This opens new scenarios for the implications in everyday clinical practice. Clinical Trial Registration Number is NCT03243123.
Highlights
Stroke represents the most common cause for adult upper limb (UL) motor impairments [1], leading for almost the 80% of hand motor function disorders as a consequence of hemiplegia [2,3,4]
Tissue perfusion of the forearm, assessed through quantification of the changes in THb within the flexor muscles, changed significantly during the synchronous modality of the intervention. This phenomenon suggests a beneficial effect of robot-assisted therapy in terms of improved regional blood flow changes during passive movements involving all fingers simultaneously which may, in turn, facilitate the washout of catabolites and pain-related molecules accumulating in the tissues of poorly active upper limbs and possibly alleviate regional pain [31, 32]
Since repetitive improved capillary supply represents an important mechanical factor for angiogenesis due to the shear stress phenomenon following increased flow, our data suggest that the synchronous modality of finger passive motion with robotic assistance may have important clinical implications for muscle tissue function and circulatory homeostasis, in light of the fact that low levels of mechanical impact, as in the case of hemiparesis, may promote endothelial cell apoptosis and capillary regression [36, 37]
Summary
Stroke represents the most common cause for adult upper limb (UL) motor impairments [1], leading for almost the 80% of hand motor function disorders as a consequence of hemiplegia [2,3,4]. Less than 45% of stroke patients are likely to achieve complete functional recovery, while the majority of this population will reveal a variable degree of residual impairment and inability to accomplish daily life activities [6,7,8,9]. Beside motor control and sensory deficits, stroke survivors present common complications such as pain, spasticity, joint constraint, and skin or vascular damage, which represent paramount challenges in stroke management [10, 11]. To counteract these problems and to help in restoring/improving upper and lower limb function, a wide range of technically advanced devices designed to assist physical rehabilitation are increasingly at disposal for therapists. Robotic devices assist patients in performing repetitive tasks (active or passive exercises), addressing
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