So after you objectively evaluate hand deficits. YOU need to come up with EXACT STROKE REHAB PROTOCOLS. WHOM is going to do the followup research that will create protocols? Or will this become another failure of stroke leadership?
Reliability, validity and discriminant ability of a robotic device for finger training in patients with subacute stroke
Abstract
Background
The majority of stroke survivors experiences significant hand impairments, as weakness and spasticity, with a severe impact on the activity of daily living. To objectively evaluate hand deficits, quantitative measures are needed. The aim of this study is to assess the reliability, the validity and the discriminant ability of the instrumental measures provided by a robotic device for hand rehabilitation, in a sample of patients with subacute stroke.Material and methods
In this study, 120 patients with stroke and 40 controls were enrolled. Clinical evaluation included finger flexion and extension strength (using the Medical Research Council, MRC), finger spasticity (using the Modified Ashworth Scale, MAS) and motor control and dexterity during ADL performance (by means of the Frenchay Arm Test, FAT). Robotic evaluations included finger flexion and extension strength, muscle tone at rest, and instrumented MAS and Modified Tardieu Scale. Subjects were evaluated twice, one day apart, to assess the test-retest reliability of the robotic measures, using the Intraclass Correlation Coefficient (ICC). To estimate the response stability, the standard errors of measurement and the minimum detectable change (MDC) were also calculated. Validity was assessed by analyzing the correlations between the robotic metrics and the clinical scales, using the Spearman’s Correlation Coefficient (r). Finally, we investigated the ability of the robotic measures to distinguish between patients with stroke and healthy subjects, by means of Mann-Whitney U tests.Results
All the investigated measures were able to discriminate patients with stroke from healthy subjects (p < 0.001). Test-retest reliability was found to be excellent for finger strength (in both flexion and extension) and muscle tone, with ICCs higher than 0.9. MDCs were equal to 10.6 N for finger flexion, 3.4 N for finger extension, and 14.3 N for muscle tone. Conversely, test-retest reliability of the spasticity measures was poor. Finally, finger strength (in both flexion and extension) was correlated with the clinical scales (r of about 0.7 with MRC, and about 0.5 with FAT).Discussion
Finger strength (in both flexion and extension) and muscle tone, as provided by a robotic device for hand rehabilitation, are reliable and sensitive measures. Moreover, finger strength is strongly correlated with clinical scales. Changes higher than the obtained MDC in these robotic measures could be considered as clinically relevant and used to assess the effect of a rehabilitation treatment in patients with subacute stroke.Background
After
stroke, most of the patients experiences a deficit at the hand and, six
months after the acute event, about 65% of patients cannot incorporate
the affected hand into their usual activities [1].
The ability to perform activities of daily living (ADL) is highly
dependent on hand function, leaving those suffering with hand
impairments less capable of executing ADL and consequently with a
reduced quality of life [2].
Grip, strength, and overall functions of the hands are often impaired,
making everyday tasks hard to accomplish and consequently compromising
severely the ability to be independent in functional activities. In
severe patients, the injured hand very often remains plegic, with
difficulty extending the fingers [3] and no marked recovery over time [4, 5], making the recovery of hand function one of the most challenging topics in stroke rehabilitation [6].
Rehabilitation of arm function after stroke has been changing substantially over the last decades [7] but, up to now, the optimal intervention is far from being identified. In the last decades, a growing interest has been addressed towards the use of robotic devices to treat the upper limb in patients suffering from neurological disease, especially stroke [8]. In fact, these devices allow to increase of the amount and intensity of the therapy, to standardize the treatment, providing a complex but controlled multisensory stimulation [9, 10] and helping the patient to complete the required task while preventing inappropriate movements [11]. Even if most of the robots focuses on the more proximal joints (shoulder and elbow) [12], some devices have been specifically developed to target the hand, using either end-effector [13,14,15] or exoskeleton [16, 17] design, with encouraging results in terms of motor recovery [12, 18,19,20,21,22].
In addition, robotic devices, because of their built-in technology in terms of sensors and actuators, are able to objectively quantify the motor status of patients after brain damage, as well as their motor recovery. In fact, such devices are able to acquire kinematic and kinetic data which are processed to obtain quantitative indices [23,24,25,26,27,28,29,30,31,32,33,34]. These robot-derived measures can potentially add meaningful information about the patient’s performance, helping the clinicians in patient’s assessment. As a condition of their use in clinical practice, however, their properties in terms of reliability, validity and responsiveness should be assessed. In fact, in order to be brought into the clinical field, the obtained measures have to be stable, sensitive and clinically meaningful.
Amadeo (Tyromotion, Austria) is a mechatronic end-effector robotic device specifically designed to treat the hand. Results from its application in stroke patients suggest its efficacy in reducing hand impairment [20, 22, 35, 36]. To the best of our knowledge, however, the psychometric properties of the measures provided by this robotic device have not yet been investigated. Therefore, the aim of the present work is to evaluate, within a multicenter randomized controlled trial, the reliability, the concurrent validity and the discriminant ability of the indices provided by a robotic rehabilitation device for hand rehabilitation.
Rehabilitation of arm function after stroke has been changing substantially over the last decades [7] but, up to now, the optimal intervention is far from being identified. In the last decades, a growing interest has been addressed towards the use of robotic devices to treat the upper limb in patients suffering from neurological disease, especially stroke [8]. In fact, these devices allow to increase of the amount and intensity of the therapy, to standardize the treatment, providing a complex but controlled multisensory stimulation [9, 10] and helping the patient to complete the required task while preventing inappropriate movements [11]. Even if most of the robots focuses on the more proximal joints (shoulder and elbow) [12], some devices have been specifically developed to target the hand, using either end-effector [13,14,15] or exoskeleton [16, 17] design, with encouraging results in terms of motor recovery [12, 18,19,20,21,22].
In addition, robotic devices, because of their built-in technology in terms of sensors and actuators, are able to objectively quantify the motor status of patients after brain damage, as well as their motor recovery. In fact, such devices are able to acquire kinematic and kinetic data which are processed to obtain quantitative indices [23,24,25,26,27,28,29,30,31,32,33,34]. These robot-derived measures can potentially add meaningful information about the patient’s performance, helping the clinicians in patient’s assessment. As a condition of their use in clinical practice, however, their properties in terms of reliability, validity and responsiveness should be assessed. In fact, in order to be brought into the clinical field, the obtained measures have to be stable, sensitive and clinically meaningful.
Amadeo (Tyromotion, Austria) is a mechatronic end-effector robotic device specifically designed to treat the hand. Results from its application in stroke patients suggest its efficacy in reducing hand impairment [20, 22, 35, 36]. To the best of our knowledge, however, the psychometric properties of the measures provided by this robotic device have not yet been investigated. Therefore, the aim of the present work is to evaluate, within a multicenter randomized controlled trial, the reliability, the concurrent validity and the discriminant ability of the indices provided by a robotic rehabilitation device for hand rehabilitation.
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