Performance-Based Robotic Training in Individuals with Subacute Stroke: Differences between Responders and Non-Responders.

The high variability of upper limb motor recovery with robotic training (RT) in subacute stroke underscores the need to explore differences in responses to RT. We explored differences in baseline characteristics and the RT dose between responders (ΔFugl-Meyer Assessment (FMA) score ≥ 9 points; = 20) and non-responders ( = 16) in people with subacute stroke (mean [SD] poststroke time at baseline, 54 (26) days, baseline FMA score, 23 (17) points) who underwent 16 RT sessions combined with conventional therapies. Baseline characteristics were compared between groups.

Robot-assisted therapy for upper limb paresis after stroke: Use of robotic algorithms in advanced practice.

Background: Rehabilitation of stroke-related upper limb paresis is a major public health issue.

Objective: Robotic systems have been developed to facilitate neurorehabilitation by providing key elements required to stimulate brain plasticity and motor recovery, namely repetitive, intensive, adaptative training with feedback. Although the positive effect of robot-assisted therapy on motor impairments has been well demonstrated, the effect on functional capacity is less certain.

Relation between Cortical Activation and Effort during Robot-Mediated Walking in Healthy People: A Functional Near-Infrared Spectroscopy Neuroimaging Study (fNIRS).

Force and effort are important components of a motor task that can impact rehabilitation effectiveness. However, few studies have evaluated the impact of these factors on cortical activation during gait. The purpose of the study was to investigate the relation between cortical activation and effort required during exoskeleton-mediated gait at different levels of physical assistance in healthy individuals.

Using Robot-Based Variables during Upper Limb Robot-Assisted Training in Subacute Stroke Patients to Quantify Treatment Dose.

In post-stroke motor rehabilitation, treatment dose description is estimated approximately. The aim of this retrospective study was to quantify the treatment dose using robot-measured variables during robot-assisted training in patients with subacute stroke. Thirty-six patients performed fifteen 60 min sessions (Session 1−Session 15) of planar, target-directed movements in addition to occupational therapy over 4 (SD 2) weeks.

Impact of Dose of Combined Conventional and Robotic Therapy on Upper Limb Motor Impairments and Costs in Subacute Stroke Patients: A Retrospective Study.

Introduction: Robot-based training integrated into usual care might optimize therapy productivity and increase treatment dose. This retrospective study compared two doses of an upper limb rehabilitation program combining robot-assisted therapy and occupational therapy on motor recovery and costs after stroke.

Methods: Thirty-six subacute stroke patients [Fugl-Meyer Assessment (FMA) score 32 ± 12 points; mean ± SD] underwent a combined program of 29 ± 3 sessions of robot-assisted therapy and occupational therapy.

Comparison of active-assisted and active-unassisted robot-mediated upper limb therapy in subacute stroke.

Background: Upper-limb robot-mediated therapy is usually carried out in active-assisted mode because it enables performance of many movements. However, assistance may reduce the patient's own efforts which could limit motor recovery.

Objective: The aim of this study was to compare the effects of active-assisted and active-unassisted robotic interactions on motor recovery in subacute stroke patients with moderate hemiparesis.

Evolution of upper limb kinematics four years after subacute robot-assisted rehabilitation in stroke patients.

To assess functional status and robot-based kinematic measures four years after subacute robot-assisted rehabilitation in hemiparesis. Twenty-two patients with stroke-induced hemiparesis underwent a ≥3-month upper limb combined program of robot-assisted and occupational therapy from two months post-stroke, and received community-based therapy after discharge. Four years later, 19 (86%) participated in this follow-up study.

Combining Upper Limb Robotic Rehabilitation with Other Therapeutic Approaches after Stroke: Current Status, Rationale, and Challenges.

A better understanding of the neural substrates that underlie motor recovery after stroke has led to the development of innovative rehabilitation strategies and tools that incorporate key elements of motor skill relearning, that is, intensive motor training involving goal-oriented repeated movements. Robotic devices for the upper limb are increasingly used in rehabilitation. Studies have demonstrated the effectiveness of these devices in reducing motor impairments, but less so for the improvement of upper limb function.

Pattern of improvement in upper limb pointing task kinematics after a 3-month training program with robotic assistance in stroke.

Background: When exploring changes in upper limb kinematics and motor impairment associated with motor recovery in subacute post stroke during intensive therapies involving robot-assisted training, it is not known whether trained joints improve before non-trained joints and whether target reaching capacity improves before movement accuracy.

Methods: Twenty-two subacute stroke patients (mean delay post-stroke at program onset 63 ± 29 days, M2) underwent 50 ± 17 (mean ± SD) 45-min sessions of robot-assisted (InMotion™) shoulder/elbow training over 3 months, in addition to conventional occupational therapy. Monthly evaluations (M2 to M5) included Fugl-Meyer Assessment (FM), with subscores per joint, and four robot-based kinematic measures: mean target distance covered, mean velocity, direction accuracy (inverse of root mean square error from straight line) and movement smoothness (inverse of mean number of zero-crossings in the velocity profile).

Cortico-thalamic disconnection in a patient with supernumerary phantom limb.

Supernumerary phantom limb (SPL) designates the experience of an illusory additional limb occurring after brain damage. Functional neuroimaging during SPL movements documented increased response in the ipsilesional supplementary motor area (SMA), premotor cortex (PMC), thalamus and caudate. This suggested that motor circuits are important for bodily related cognition, but anatomical evidence is sparse.

Does assist-as-needed upper limb robotic therapy promote participation in repetitive activity-based motor training in sub-acute stroke patients with severe paresis?

Background: Repetitive, active movement-based training promotes brain plasticity and motor recovery after stroke. Robotic therapy provides highly repetitive therapy that reduces motor impairment. However, the effect of assist-as-needed algorithms on patient participation and movement quality is not known.

Upper limb robotics applied to neurorehabilitation: An overview of clinical practice.

Background: During the last two decades, extensive interaction between clinicians and engineers has led to the development of systems that stimulate neural plasticity to optimize motor recovery after neurological lesions. This has resulted in the expansion of the field of robotics for rehabilitation. Studies in patients with stroke-related upper-limb paresis have shown that robotic rehabilitation can improve motor capacity.

When brain damage "improves" perception: neglect patients can localize motion-shifted probes better than controls.

When we look at bars flashed against a moving background, we see them displaced in the direction of the upcoming motion (flash-grab illusion). It is still debated whether these motion-induced position shifts are low-level, reflexive consequences of stimulus motion or high-level compensation engaged only when the stimulus is tracked with attention. To investigate whether attention is a causal factor for this striking illusory position shift, we evaluated the flash-grab illusion in six patients with damaged attentional networks in the right hemisphere and signs of left visual neglect and six age-matched controls.

Effects of prolonged robot-assisted training on upper limb motor recovery in subacute stroke.

Background: High intensity and early initiation of rehabilitation have been extensively demonstrated to enhance neural plasticity and motor recovery after stroke. However, the optimal duration of rehabilitation programs in order to have the highest impact on motor outcomes has not been established.

Objectives: To evaluate motor outcomes in subacute stroke survivors with moderate to severe upper limb paresis over an extended period of rehabilitation consisting of usual care augmented with a large number of upper limb robot-assisted sessions (54 ± 13 sessions).