Robot-assisted upper limb training combined with Botulinum toxin injection in the treatment of upper limb spasticity: a randomised single-blinded controlled trial

In multiple sclerosis so your doctor won't even think of trying to extrapolate this knowledge to stroke. If you have spasticity you are totally fucking screwed.  I've had it for 14 years and it hasn't relented one bit.  Fix my spasticity and I will easily recover my motor functions from dead areas.

Robot-assisted upper limb training combined with Botulinum toxin injection in the treatment of upper limb spasticity: a randomised single-blinded controlled trial

2019, Frontiers in Neurology


ORIGINAL RESEARCH
published: 24 October 2018doi: 10.3389/fneur.2018.00905Frontiers in Neurology | www.frontiersin.org
 1
 October 2018 | Volume 9 | Article 905
 Edited by:
Giovanni Abbruzzese,Università di Genova, Italy
 Reviewed by:
Paolo Tonin,Sant’Anna Institute, Italy Giovanni Morone,Fondazione Santa Lucia (IRCCS), Italy
*Correspondence:
Marialuisa Gandolfi  marialuisa.gandolfi@univr.it
Specialty section:
This article was submitted toNeurorehabilitation, a section of the journal Frontiers in Neurology
 Received:
 03 August 2018
 Accepted:
 05 October 2018
 Published:
 24 October 2018
Citation:
Gandolfi M, Valè N, Dimitrova EK,Mazzoleni S, Battini E, Benedetti MD,Gajofatto A, Ferraro F, Castelli M,Camin M, Filippetti M, De Paoli C,Chemello E, Picelli A, Corradi J,Waldner A, Saltuari L and Smania N (2018) Effects of High-intensity Robot-assisted Hand Training onUpper Limb Recovery and Muscle Activity in Individuals With MultipleSclerosis: A Randomized, Controlled,Single-Blinded Trial.Front. Neurol. 9:905.doi: 10.3389/fneur.2018.00905
Effects of High-intensity Robot-assisted Hand Training onUpper Limb Recovery and Muscle Activity in Individuals With MultipleSclerosis: A Randomized, Controlled,Single-Blinded Trial
Marialuisa Gandolfi 1*  , 

Nicola Valè 1 , 

Eleonora Kirilova Dimitrova 1 , 

Stefano Mazzoleni  2,

Elena Battini  2, 

Maria Donata Benedetti 1, 

Alberto Gajofatto 1, 

Francesco Ferraro 3 ,

Matteo Castelli 4 , 

Maruo Camin 4, 

Mirko Filippetti 1 , 

Carola De Paoli 1 , 

Elena Chemello 1, 

Alessandro Picelli 1,5 , 

Jessica Corradi 1 , 

Andreas Waldner 6 , 

Leopold Saltuari 7,8 

and Nicola Smania 1,5

1 Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy,
 2 The BioRobotics Institute, Scuola Superiore Sant’ Anna, Polo Sant’ Anna Valdera, Pontedera, Italy,
 3 Section of Neuromotor Rehabilitation,Department of Neuroscience, ASST Carlo Poma, Mantova, Italy,
 4 Centro di riabilitazione Franca Martini—ATSM ONLUS,Trento, Italy,
 5 UOC Neurorehabilitation, AOUI Verona, Verona, Italy,
 6 Department of Neurological Rehabilitation, PrivateHospital Villa Melitta, Bolzano, Italy,
 7 Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy,
 8Department of Neurology, Hochzirl Hospital, Zirl, Austria
Background:
Integration of robotics and upper limb rehabilitation in people with multiple sclerosis (PwMS) has rarely been investigated.
Objective:
 To compare the effects of robot-assisted hand training against non-robotic hand training on upper limb activity in PwMS. To compare the training effects on hand dexterity, muscle activity, and upper limb dysfunction as measured with the International Classification of Functioning.
Methods:
 This single-blind, randomized, controlled trial involved 44 PwMS (Expanded Disability Status Scale:1.5–8) and hand dexterity deficits. The experimental group (n =23) received robot assisted hand training; the control group(n=21) received nonrobotic hand training. Training protocols lasted for 5 weeks (50 min/session, 2 sessions/week).Before (T0), after (T1), and at 1 month follow-up (T2), a blinded rater evaluated patients using a comprehensive test battery. Primary outcome: Action Research Arm Test. Secondary outcomes: Nine Holes Peg Test; Fugl-Meyer Assessment Scale–upperextremity section; Motricity Index; Motor Activity Log; Multiple Sclerosis (MS) Quality of Life
−
54; Life Habits assessment—general short form and surface electromyography.
Results:
 There were no significant between-group differences in primary and secondary outcomes. Electromyography showed relevant changes providing evidence increased activity in the extensor carpi at T1 and T2