Systematic review of outcome measures of walking training using electromechanical and robotic devices in patients with stroke

Of the scales listed I only did the 10 meter Walk test and the Berg Balance. I thought the Berg Balance was useless, there was nothing done after failing parts of the test to fix those problems.  There should have been protocols to fix the failure on not being able to stand one legged on the affected leg.

Systematic review of outcome measures of walking training using electromechanical and robotic devices in patients with stroke

2013, Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine
 Christian Geroin, PT 1*, 

Stefano Mazzoleni, PhD 3*, 

Nicola Smania, MD 1,2, 

Marialuisa Gandolf,MD, PhD 1, 

Donatella Bonaiuti, MD 4, 

Giulio Gasperini, MD 5, 

Daniele Munari, PT 1, 

Patrizio Sale, MD, PhD 6, 

Andreas Waldner, MD 7, 

Raffaele Spidalieri, MD 8, 

Federica Bovolenta, MD 9, 

Alessandro Picelli, MD 1, 

Federico Posteraro, MD 10, 

Franco Molteni, MD 5, 

Marco Franceschini, MD 6 

and the Italian Robotic Neurorehabilitation Research Group (IRNRG)
From the
1 Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), Department of Neurological and Movement Sciences, University of Verona,
2 Neurological Rehabilitation Unit Azienda Ospedaliera-Universitaria Integrata Verona,
3 The BioRobotics Institute, Scuola Superiore Sant’Anna, Pisa,
4 Physical Medicine and Rehabilitation Department, S. Gerardo Hospital, Monza,
5 Department of Rehabilitation Medicine, Ospedale Valduce, Villa Beretta, Costamasnaga, Lecco,
6 Department of Rehabilitation IRCCS San Raffaele Pisana, Rome,
7 Department of Neurological Rehabilitation, Private Hospital Villa Melitta, Bolzano,
8 Istituto di Riabilitazione Neurologica “Madre Della Divina Prov- videnza” di Agazzi, Arezzo,
9 Medicine Rehabilitation NOCSAE Hospital AUSL of Modena, Modena and
10 Neurological Rehabilitation Unit, Auxilium Vitae Rehabilitation Center, Volterra, Italy. *Both authors contributed equally to this work.
   Objective:
 The aim of this systematic review was to identify appropriate selection criteria of clinical scales for future trials, starting from those most commonly reported in the literature, according to their psychometric properties and
International Classication of Functioning, Disability and Health (ICF) domains.
 Data sources:
A computerized literature research of articles
was conducted in MEDLINE, EMBASE, CINALH, Pub-Med, PsychINFO and Scopus databases.
 Study selection:
 Clinical trials evaluating the effects of electromechanical and robot-assisted gait training trials in stroke survivors.
 Data extraction:
Fifteen independent authors performed an extensive literature review.
 Data synthesis:
 A total of 45 scales was identied from 27 studies involving 966 subjects. The most commonly used outcome measures were: Functional Ambulation Category (18 studies), 10-Meter Walking Test (13 studies), Motricity Index (12 studies), 6-Minute Walking Test (11 studies), Rivermead Mobility Index (8 studies) and Berg Balance Scale (8 studies). According to the ICF domains 1 outcome measure was categorized into Body Function and Structure, 5 into Activity and none into Participation.
Conclusion:
The most commonly used scales evaluated the basic components of walking. Future studies should also include instrumental evaluation. Criteria for scale selection should be based on the ICF framework, psychometric properties and patient characteristics.
 Key words:
 stroke; lower limb; rehabilitation; motor recovery; robot; training; therapy; physiotherapy; function; study; robot- assisted, trial. J Rehabil Med 2013; 45: 987–996
Correspondence address: Christian Geroin, Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), Depart-ment of Neurological, and Movement Sciences, University of Verona, 37134 Verona, Italy. E-mail: christian.geroin@univr.it
Accepted Jun 17, 2013; Epub ahead of print Oct 17, 2013

Instrumental indices for upper limb function assessment in stroke patients: a validation study

Maybe we are finally getting to some objective measurements of physical  impairments. It's about fucking time, all these other measurement tools do nothing to tell you anything specific. A great stroke association president would have initiated objective diagnosis and measurement decades ago. But we've had decades of failure to contend with and I still see NO hope in the forseeable future.

Instrumental indices for upper limb function assessment in stroke patients: a validation study

• Maria Longhi,
• Andrea MerloEmail author,
• Paolo Prati,
• Meris Giacobbi and
• Davide Mazzoli

Journal of NeuroEngineering and Rehabilitation201613:52

DOI: 10.1186/s12984-016-0163-4

©  The Author(s). 2016

Received: 11 December 2015

Accepted: 3 June 2016

Published: 8 June 2016

Abstract

Background

Robotic exoskeletons are increasingly being used in objective and quantitative assessment of upper limb (UL) movements. A set of instrumental indices computed during robot-assisted reaching tasks with the Armeo®Spring has been proven to assess UL functionality. The aim of this study was to test the construct validity of this indices-based UL assessment when used with patients who have had a stroke.

Methods

Forty-four 45- to 79-year-old stroke patients with a Wolf Motor Function Test ability score (WMFT-FAS) ranging from 10 to 75 and a Motricity Index (MI) ranging from 14 to 33 at shoulder and elbow were enrolled, thus covering a wide range of impairments. Residual UL function was assessed by both the WMFT-FAS and the WMFT-TIME, as well as by a set of 9 numerical indices assessing movement accuracy, velocity and smoothness computed from a 3D endpoint trajectory obtained during the “Vertical Capture” task of the Armeo®Spring device. To explore which variables better represented motor control deficits, the Mann-Whitney U Test was used to compare patients’ indices to those obtained from 25 healthy individuals. To explore the inner relationships between indices and construct validity in assessing accuracy, velocity and smoothness, a factor analysis was carried out. To verify the indices concurrent validity, they were compared to both WMFT-FAS and WMFT-TIME by the Spearman’s correlation coefficient.

Results

Seven indices of stroke subjects were significantly different from those of healthy controls, with effect sizes in the range 0.35–0.74. Factor analysis confirmed that specific subsets of indices belonged to the domains of accuracy, velocity and smoothness (discriminant validity). One accuracy index, both velocity indices and two smoothness indices were significantly correlated with WMFT-FAS and WMFT-TIME (|rho|  = 0.31–0.50) (concurrent validity). One index for each of the assessed movement domains was proven to have construct validity (discriminant and concurrent) and was selected. Moreover, the indices were able to detect differences in accuracy, velocity and/or smoothness in patients with the same WMFT level.

Conclusions

The proposed index-based UL assessment can be used to integrate and support clinical evaluation of UL function in stroke patients.

Relationship between clinical and instrumental balance assessments in chronic post-stroke hemiparesis subjects

Your therapist can evaluate this to see if they need to make changes to your stroke protocols. 

Relationship between clinical and instrumental balance assessments in chronic post-stroke hemiparesis subjects

Abstract (provisional)

Background

Stroke is often associated with balance deficits that increase the risk of falls and may lead to severe mobility disfunctions or death. The purpose of this study is to establish the relation between the outcome of instrumented posturography and of the most commonly used clinical balance tests, and investigate their role for obtaining reliable feedback on stroke patients' balance impairment.

Methods

Romberg test was performed on 20 subjects, 10 hemiplegic post-stroke subjects (SS, 69.4 +/- 8.2 years old) and 10 control subjects (CS, 61.6 +/- 8.6 years old), with 1 Bertec force plate. The following parameters were estimated from the centre of pressure (CoP) trajectory, which can be used to define subjects' performance during the balance task: sway area; ellipse (containing 95% of the data); mean CoP path and velocity in the anterior-posterior and medio-lateral directions. The following clinical scales and tests were administered to the subjects: Tinetti Balance test (TB); Berg Balance test (BBT); Time up and go test (TUG), Fugl-Meyer (lower limbs) (FM), Motricity Index (lower limbs), Trunk Control Test, Functional Independence Measure. Comparison between SS and CS subjects was performed by using the Student t-test. The Pearson Correlation coefficient was computed between instrumental and clinical parameters.

Results

Mean +/- standard deviation for the balance scales scores of SS were: 12.5 +/- 3.6 for TB, 42.9 +/- 13.1 for BBT, 24 s and 75 cent +/- 25 s and 70 cent for TUG. Correlation was found among some CoP parameters and both BBT and TUG in the eyes open and closed conditions (0.9 <= R <= 0.8). Sway area correlated only with TUG. Statistically significant differences were found between SS and CS in all CoP parameters in eyes open condition (p < 0.04); whereas in eyes closed condition only CoP path and velocity (p < 0.02) differed significantly.

Conclusions

Correlation was found only among some of the clinical and instrumental balance outcomes, indicating that they might measure different aspects of balance control. Consistently with previous findings in healthy and pathological subjects, our results suggest that instrumented posturography should be recommended for use in clinical practice in addition to clinical functional tests.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Hand Robotics Rehabilitation: Feasibility and Preliminary Results of a Robotic Treatment in Patients with Hemiparesis

This is bad science. With no diagnosis of where and what kind of damage to the motor cortex this was stupid to even attempt this. If the hand control area was dead then of course 4 weeks won't do anything. If it was penumbra damage then it might work. Damn, don't we have any stroke scientists with a modicum of intelligence?
http://scholar.google.com/scholar_url?hl=en&q=http://downloads.hindawi.com/journals/srt/2012/820931.pdf&sa=X&scisig=AAGBfm364oWUH3BDIxEv3FGwAF3OPLKCkw&oi=scholaralrt
 Background. No strongly clinical evidence about the use of hand robot-assisted therapy in stroke patients was demonstrated. This
preliminary observer study was aimed at evaluating the efficacy of intensive robot-assisted therapy in hand function recovery,
in the early phase after a stroke onset. Methods. Seven acute ischemic stroke patients at their first-ever stroke were enrolled.
Treatment was performed using Amadeo robotic system(Tyromotion GmbH Graz, Austria). Each participant received, in addition
to inpatients standard rehabilitative treatment, 20 sessions of robotic treatment for 4 consecutive weeks (5 days/week). Each session
lasted for 40 minutes. The exercises were carried out as follows: passive modality (5 minutes), passive/plus modality (5 minutes),
assisted therapy (10 minutes), and balloon (10 minutes). The following impairment and functional evaluations, Fugl-Meyer Scale
(FM), Medical Research Council Scale for Muscle Strength (hand flexor and extensor muscles) (MRC), Motricity Index (MI), and
modified Ashworth Scale for wrist and handmuscles (AS), were performed at the beginning (T0), after 10 sessions (T1), and at the
end of the treatment (T2). The strength hand flexion and extension performed by Robot were assessed at T0 and T2. The Barthel
Index and COMP (performance and satisfaction subscale) were assessed at T0 and T2. Results. Clinical improvements were found
in all patients. No dropouts were recorded during the treatment and all subjects fulfilled the protocol. Evidence of a significant
improvement was demonstrated by the Friedman test for the MRC (P < 0.0123). Evidence of an improvement was demonstrated
for AS, FM, and MI. Conclusions. This original rehabilitation treatment could contribute to increase the hand motor recovery in
acute stroke patients. The simplicity of the treatment, the lack of side effects, and the first positive results in acute stroke patients
support the recommendations to extend the clinical trial of this treatment, in association with physiotherapy and/or occupational
therapy.

Ergoloids and ischaemic strokes; efficacy and mechanism of action

Only 17 years old so ask your doctior what happened to this line of research. Send him/her back to school to figure it out.
http://www.ncbi.nlm.nih.gov/pubmed/7649339

Abstract

In this double-blind, randomized study the efficacy of the ergoloid compounds, co-dergocrine mesylate and nicergoline, in the rehabilitation of patients with ischaemic stroke was investigated. A group of 30 patients was treated daily with 60 mg nicergoline, orally, and a second group of 27 patients was given 1.8-6 mg co-dergocrine mesylate, orally or intramuscularly, daily (depending on the time since the initial ischaemic insult) for 6 months. Outcome measures included: motoricity index (limb function); Sandoz Clinical Assessment Geriatric (SCAG) scale; psychometric tests to assess functions such as attention, psychomotor performance, perception and sensory and short-term memory; conventional and computerized electroencephalography; and P300 and reaction time measures. The results showed improvements in some aspects such as limb function (P less than 0.05), SCAG score (P less than 0.01) and some electrophysiological parameters (P less than 0.01) after treatment with both drugs. Though statistically significant most of the changes were not large. The efficacy of both drugs was qualitatively similar. The quantitative difference in some aspects in favour of nicergoline could be attributed to differences in the mechanisms of action of the two drugs, although it is also possible that the difference may reflect the dosages used. Nootropic drugs may induce a condition that facilitates the effects of cognitive training.

Observation-to-Imitate Plus Practice Could Add Little to Physical Therapy Benefits Within 31 Days of Stroke: Translational Randomized Controlled Trial

This is so simple, set up clinical trials for different time periods. This is still during spontaneous recovery so trying to determine specific effects of various therapies is difficult.
http://nnr.sagepub.com/cgi/content/abstract/27/2/173?etoc

Abstract

Background and Purpose. Observation of action with intention-to-imitate (OTI) might enhance motor recovery. This early phase trial investigated whether OTI followed by physical practice (OTI + PP) enhanced the benefits of conventional physical therapy (CPT) on upper limb recovery early after stroke. Methods. Participants were 3 to 31 days poststroke. They had substantial paresis and ability to imitate action with their ipsilesional arm. After baseline measures, participants were randomized to either OTI + PP in addition to CPT or to CPT only. Outcome measures were made after 15 days of treatment. The measurement battery was the Motricity Index (MI) and the Action Research Arm Test (ARAT). Change, baseline to outcome, was examined using the Wilcoxon test for within group and Mann–Whitney U test for between groups. Results. Sixty-five of 570 stroke survivors were eligible, 55 were able to imitate, 37 gave informed consent, 7 were transferred out of area before baseline, and 29 were randomized. Outcome measures were completed with 13 CPT participants and 9 OTI + PP participants. Both groups showed statistically significant improvements for the MI (CPT median change 8, P = .003; OTI + PP median change 10, P = .012) but the median (95% confidence interval [CI]) between-group difference was 0.0 (−11, 16), P = 1.000. For the ARAT, only the CPT group showed a statistically significant improvement (median 9, P = .006). The median (95% CI) between-group difference of 1.0 (−18, 23) was not statistically significant (P = .815). Conclusions. These findings suggest that OTI + PP might add little to the benefits of CPT early after stroke.

Efficacy of Armeo(®)Spring during the chronic phase of stroke. Study in mild to moderate hemiparesis cases

I suggest that the gravity reduction is the main reason for the benefit and you can do the same thing with my cane exercises. But don't listen to me, I'm not medically trained and those exercises are obviously too dangerous to be used without your doctors ok. Good luck on getting that approval.
http://www.ncbi.nlm.nih.gov/pubmed/22727271

Abstract

OBJECTIVE:

To evaluate the efficacy of a gravity-supported, computer-enhanced device (Armeo(®)Spring) for upper limb rehabilitation in chronic stroke patients.

MATERIAL AND METHODS:

We included 23 chronic hemiparetic patients (chronicity: 328 ± 90.8 days; distribution: 17 men and 6 women) aged 54.6 ± 9.5 years, who had sustained ischaemic (n=12) or haemorrhagic (n=11) stroke. All patients completed 36 one-hour sessions using the Armeo(®)Spring system. Arm movement was assessed at the beginning and end of the treatment programme, and once more 4 months later. Main outcome measurements covered structure, activity, and function, as per the International Classification of Functioning, Disability and Health: Modified Ashworth Scale, Motricity Index (MI), Fugl-Meyer Assessment Scale (FM), Motor Assessment Scale (MAS), Manual Function Test (MFT), and Wolf Motor Function Test (WMFT).

RESULTS:

Repeated measures ANOVA showed significant improvement (time effect) for all function scales (P<.01 for FM and MI) and activity scales (P<.01 for MAS, MFT and WMFT-ability, and P<.05 WMFT-time) without significant changes in muscle tone. The post-hoc analysis (Bonferroni) showed different evolutionary patterns for function and activity measurements, and clear benefits related to Armeo(®)Spring training, especially on activity scales.

CONCLUSIONS:

Armeo(®)Spring is an effective tool for rehabilitating the affected arm in patients with hemiparesis secondary to ictus, even in the chronic stage.

Test-retest reliability of Motricity Index strength assessments for lower extremity in post stroke hemiparesis

I hadn't heard of this test. But this still needs to map these tests to a damage diagnosis to do any good.
Its only 4 pages long. Even Iran can do some decent research. 

Test-retest reliability of Motricity Index strength assessments for lower extremity in post stroke hemiparesis

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