And that future is bleak since no one knows EXACTLY how to make neuroplasticity repeatable on demand!
Robot- and Technology-Boosting Neuroplasticity-Dependent Motor-Cognitive Functional Recovery: Looking towards the Future of Neurorehabilitation
by
6,7,8
, 4, 3 and 1
4, 3 and 1
and 1
1
Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
2
San Raffaele Institute of Sulmona, Viale dell’Agricoltura, 67039 Sulmona, Italy
3
Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy
4
Santa Lucia Foundation, Scientific Institute for Research, Hospitalization and Health Care (IRCCS), 00179 Rome, Italy
5
Neurorehabilitation Unit, IRCCS Neurolesi Center “Bonino-Pulejo”, 98124 Messina, Italy
6
S’Anna Institute, 88900 Crotone, Italy
7
Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy
8
Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy
*
Author to whom correspondence should be addressed.
Brain Sci. 2023, 13(12), 1687; https://doi.org/10.3390/brainsci13121687
Original submission received: 1 November 2023
/
Accepted: 15 November 2023
/
Published: 7 December 2023
(This article belongs to the Special Issue Robot-,
Virtual Reality- and Sensor-Based Therapies Boosting Neuroplasticity in
the Context of Motor and Cognitive Neurorehabilitation: Current State
of the Art and Applications)
The sequelae of neurological disorders are the
leading causes of disability in all industrialized countries.
Conventional rehabilitation usually allows a small proportion of
patients suffering from neurological disabilities to completely recover
independent walking or functional grasping, and other activities of
daily living [1].
For these reasons, an increasing number of research studies and
randomized clinical trials are pursuing the use of new robots and
technologies to improve the efficacy of rehabilitation [2,3,4,5,6].
They have become more usable and widespread every year, thanks to new
principles of neuroscience translated into clinical practice through
technological innovations. However, despite their diffusion in
neurorehabilitation, many questions remain unanswered.
In particular, the disputes about their efficacy, together with the high purchase cost for most of these devices [7,8],
the absence of clear and univocal guidelines for better dosages to use
and parameter values to set, and the somewhat diffuse skepticism of some
members of the rehabilitation teams, may limit their use in clinical
settings.
Finally, most of the available
studies and clinical indications focus on stroke and multiple sclerosis,
even though robots might be beneficial for other pathologies, such as
Parkinson’s disease, traumatic brain injuries, spinal cord injuries, and
other brain degenerative diseases [9,10,11].
This
Special Issue aims to provide an overview of the use of new
technologies in the neurorehabilitation of people with motor and
cognitive disabilities stemming from central nervous system diseases.
In
general, studies address the effectiveness of therapy versus
conventional therapy, while in daily clinical practice, the clinician
must choose the suitable type of neurorehabilitation assisted by a
specific robot for each specific patient [12].
For this reason, in recent years, the ideal type of robot and related
cognitive stimulation for patients with specific characteristics has
been investigated in line with personalized medicine [13,14].
Therefore, a Special Issue that addresses the use of technologies in
multiple types of patients and for different objectives can represent a
step forward in increasing our knowledge on the topic and arriving at a
competent and skillful use of robotics and technology in
neurorehabilitation clinics.
In this Special
Issue, two systematic reviews investigated the efficacy of
robot-assisted gait training (RAGT) on balance recovery using overground
exoskeletons (Lorusso M et al.) and of many different robotic devices
including overground exoskeletons, grounded exoskeletons, and
end-effectors (Loro A et al.). Xie et al. investigated the optimal
intervention timing of RAGT, with two protocols allowing us to better
understand the clinical effects of robot-assisted therapy for arm
function recovery (Pournajaf S. et al.) and for walking recovery
(Kolářová, B et al.) by means of two distinct, well-planned, and
methodologically rigorous randomized controlled trials. Finally, a
feasibility study investigated the use of an intelligent algorithm based
on an assist-as-needed controller in RAGT, which was conducted by
Laszlo C. and co-authors.
But, robots are not
the only emerging technology in neurorehabilitation. In two pilot
studies by De Luca R and a systematic review, the potential of virtual
reality (VR) in neurorehabilitation was examined. The first study looked
at how executive functioning and coping mechanisms in traumatic brain
injury patients might be improved with VR-based cognitive rehabilitation
training, and the second examined how traumatic brain injury patients’
attention processes might be affected by non-immersive VR training. The
systematic review was conducted by Martino Cinnera et al. and explored
the efficacy of VR in patients with unilateral spatial neglect due to
stroke. Regarding the gender differences in subjects affected by
traumatic brain injuries, Bruschetta R et al. demonstrated that females
who underwent VR training showed better cognitive recovery.
The
technologies aiming to modulate neuroplasticity and thus improve the
function for reducing pain should be combined to allow for an
improvement in the clinical effects. This is the case of two studies in
this Special Issue. In one study, De Luca R et al. combined robotic
verticalization and music therapy in chronic disorders of consciousness,
and in another study, Calabrò et al. combined transcranial magnetic
stimulation and muscle vibration for women with chronic pelvic pain.
Sato
M. et al. investigated the different contributions of the frequency and
the duration of PES, peripheral sensory nerve electrical stimulation,
on the excitability of the primary motor cortex. Facciorusso S. et al.
performed a bibliometric analysis of research trends regarding
sensor-based rehabilitation in neurological diseases.
Finally,
a study conducted by Varalta V. et al. demonstrated an improvement in
global cognitive status and in attention functions when subjects
affected by Parkinson’s disease were treated with an upper limb motor
protocol, underlining the strong interconnections that exist between
motor and cognitive functions for the upper limbs.
There
is no doubt that robots and technologies are changing clinicians’ ways
of thinking in rehabilitation, and even if they are not the definitive
solution for improving plasticity-dependent functional recovery, they
will certainly play a fundamental role in improving the efficacy of
neurorehabilitation.
Author Contributions
Conceptualization,
M.I., I.C. and G.M.; writing—original draft preparation, G.M.;
writing—review and editing. All authors performed a review and editing.
All authors have read and agreed to the published version of the
manuscript.
Funding
This research received no external funding.
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