https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-017-0315-1
- Ophélie PilaEmail author,
- Christophe Duret,
- François-Xavier Laborne,
- Jean-Michel Gracies,
- Nicolas Bayle and
- Emilie Hutin
Journal of NeuroEngineering and Rehabilitation201714:105
© The Author(s). 2017
Received: 23 December 2016
Accepted: 3 October 2017
Published: 13 October 2017
Abstract
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). We assessed delays to reach
statistically significant improvement for each outcome measure.
Results
At M5, all clinical and
kinematic parameters had markedly improved: Fugl-Meyer, +65% (median);
distance covered, +87%; mean velocity, +101%; accuracy, +134%; and
smoothness, +96%. Delays to reach statistical significance were M3 for
the shoulder/elbow Fugl-Meyer subscore (+43%), M4 for the hand (+80%)
and M5 for the wrist (+133%) subscores. For kinematic parameters, delays
to significant improvements were M3 for distance (+68%), velocity
(+65%) and smoothness (+50%), and M5 for accuracy (+134%).
Conclusions
An intensive rehabilitation
program combining robot-assisted shoulder/elbow training and
conventional occupational therapy was associated with improvement in
shoulder and elbow movements first, which suggests focal
behavior-related brain plasticity. Findings also suggested that recovery
of movement quantity related parameters (range of motion, velocity and
smoothness) might precede that of movement quality (accuracy).
Trial registration
EudraCT 2016–005121-36. Date of Registration: 2016–12-20. Date of enrolment of the first participant to the trial: 2009–11-24 (retrospective data).
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