Abstract
This study was aimed at verifying the improvement on the motor impairment and functionality in 19 patients with chronic hemiparesis after stroke treated with a robot-aided rehabilitation protocol using the ReoGo™ system (Motorika Medical Ltd, Israel), and at evaluating the persistence of the effects after 1 month. The study also focused on the actual possibility of administering the robot-aided therapy with the ReoGo™ for the upper limbs and on the patients' degree of acceptance and compliance with the treatment. Subjects underwent an assessment prior to the start of the rehabilitation project (T-1), one at the start (T0), one at the end of the treatment (T1) and one after one month from the end of the treatment (T2). The following tests were administered: (i) Fugl-Meyer (FM) upper limb; Ashworth scale (AS); Functional Independence Measure (FIM™) (T-1 - T2); (ii) strength evaluation; Visual Analogue Scale (VAS) for pain; Frenchay Arm test (FAT); Box and Block test (BBT); Timed Up and Go (TUG) test (T0 - T2). Additionally, the Euro-QoL questionnaire and a VAS for the treatment satisfaction were administered to the subjects. Non-statistical difference of scores at T-1 and T0 on almost the entire battery of tasks suggested a stable patients' performance prior to the start of the rehabilitation. With the exception of the Medical Research Council (MRC) and the AS sub-scales measuring -as appropriate- strength and spasticity of the shoulder, triceps and wrist, all scores showed a significant increase between T0 and T1. The improvement on the pain could not be proved significant (p = 0.10). A significant increase between T0 and T2 was found for all assessment scores, with the exception of the MRC for external shoulder rotators (p = 0.05) and of the AS for shoulder (p = 0.32) and wrist (p = 0.08). Substantial stability was observed between T1 and T2. Patients were capable of completing the treatment and showed good participant satisfaction. This pilot study led to the finding of a clinical improvement and excellent patients compliance. It is possible that the learning process experienced by the patients was robot-dependent, especially in consideration of the general maintenance of the achievements observed on all activities.
Highlights
This study was aimed at verifying the improvement on the motor impairment and functionality in 19 patients with chronic hemiparesis after stroke treated with a robot-aided rehabilitation protocol using the ReoGoTM system (Motorika Medical Ltd, Israel), and at evaluating the persistence of the effects after 1 month
Stroke is currently the most important cause of disability in industrialized countries; it is the main cause of functional impairment of the upper limbs, with important effects on participation to activities of daily living [1]
The upper limbs remain non-functional at 6 months post stroke in 30%-66% of cases, while only 5%-20% of the patients fully recover upper limbs functionality [2]
Summary
The increase in the motor FIMTM and the decrease on the VAS for the pain might be due to different strategies developed by the patients for compensating their motor deficits This data is in accordance with Lauretani [2010] who observed a functional recovery after a rehabilitation treatment in patients discharged to home [24]. Stronger evidence would be beneficial when coming to make the decision of using robotic devices as an integral part of the rehabilitation team activities, within a rehabilitation project designed to the specifications and objective requirements of each patient In this context, subjects at different disease stages (i.e. patients in the acute and sub-acute phases) should be considered in future research. The significant improvements found from the baseline measurements to the end of the treatment may be an
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