Effects of a robot-assisted training of grasp and pronation/supination in chronic stroke: a pilot study

I'm sure survivors with spasticity were not included in this testing.

 Effects of a robot-assisted training of grasp and pronation/supination in chronic stroke: a pilot study

Olivier Lambercy 1,2* , Ludovic Dovat 1 , Hong Yun 3 , Seng Kwee Wee 3 , Christopher WK Kuah 3 , Karen SG Chua 3 , Roger Gassert 2 , Theodore E Milner 4 , Chee Leong Teo 1 and Etienne Burdet 5,1 Abstract 

Background: 

Rehabilitation of hand function is challenging, and only few studies have investigated robot-assisted rehabilitation focusing on distal joints of the upper limb. This paper investigates the feasibility of using the HapticKnob, a table-top end-effector device, for robot-assisted rehabilitation of grasping and forearm pronation/ supination, two important functions for activities of daily living involving the hand, and which are often impaired in chronic stroke patients. It evaluates the effectiveness of this device for improving hand function and the transfer of improvement to arm function. 

Methods: 

A single group of fifteen chronic stroke patients with impaired arm and hand functions (Fugl-Meyer motor assessment scale (FM) 10-45/66) participated in a 6-week 3-hours/week rehabilitation program with the HapticKnob. Outcome measures consisted primarily of the FM and Motricity Index (MI) and their respective subsections related to distal and proximal arm function, and were assessed at the beginning, end of treatment and in a 6-weeks follow-up. 

Results: 

Thirteen subjects successfully completed robot-assisted therapy, with significantly improved hand and arm motor functions, demonstrated by an average 3.00 points increase on the FM and 4.55 on the MI at the completion of the therapy (4.85 FM and 6.84 MI six weeks post-therapy). Improvements were observed both in distal and proximal components of the clinical scales at the completion of the study (2.00 FM wrist/hand, 2.55 FM shoulder/elbow, 2.23 MI hand and 4.23 MI shoulder/elbow). In addition, improvements in hand function were observed, as measured by the Motor Assessment Scale, grip force, and a decrease in arm muscle spasticity. These results were confirmed by motion data collected by the robot. Conclusions: The results of this study show the feasibility of this robot-assisted therapy with patients presenting a large range of impairment levels. A significant homogeneous improvement in both hand and arm function was observed, which was maintained 6 weeks after end of the therapy.

The Effects of Unilaterally Compliant Terrain on Human Gait: Toward Robot-Assisted Model-Informed Post-stroke Gait Rehabilitation

 Your competent? doctor can read this 24 page dissertation and see if anything here will help your recovery! DO YOU  HAVE A COMPETENT DOCTOR?

The Effects of Unilaterally Compliant Terrain on Human Gait: Toward Robot-Assisted Model-Informed Post-stroke Gait Rehabilitation

Effect of Therapist-Based Versus Robot-Assisted Bilateral Arm Training on Motor Control, Functional Performance, and Quality of Life After Chronic Stroke: A Clinical Trial

 Cherry picking and I see no reference to any protocol. But they have had 8 years to make it better, I'm not looking for it, your doctor should know about followup to this.

Effect of Therapist-Based Versus Robot-Assisted Bilateral Arm Training on Motor Control, Functional Performance, and Quality of Life After Chronic Stroke: A Clinical Trial

2012, Physical Therapy
 Ching-yi Wu, Chieh-ling Yang, Li-ling Chuang, Keh-chung Lin, Hsieh-ching Chen,Ming-de Chen, Wan-chien Huang
Background.
 Although bilateral arm training (BAT) has been widely studied, the comparative effects of therapist-based BAT (TBAT) versus robot-assisted BAT (RBAT) remained unknown.
Objective.
 This study compared the efficacy of TBAT, RBAT, and a control treatment (CT) on motor control, functional performance, and quality of life after chronic stroke.
Design.
 A randomized, pretest posttest, control group design was used.
Methods.
 Forty-two patients (mean age=54.49 years, SD=9.69; mean length of time since stroke onset=17.62 months, SD=10.50) were randomly assigned to TBAT,RBAT, and CT groups. Each group received treatment for 90 to 105 minutes per session, 5 sessions on weekdays, for 4 weeks. Outcome measures included kinematicanalyses, the Fugl-Meyer Assessment (FMA), the Motor Activity Log, and the StrokeImpact Scale (SIS).
Results.
 Large and significant effects were found in the kinematic variables, distal part of upper-limb motor impairment, and certain aspects of quality of life in favor of TBAT or RBAT. Specifically, the TBAT group demonstrated significantly better temporal efficiency and smoothness, straighter trunk motion, and less trunk compensation compared with the CT and RBAT groups. The RBAT group had increased shoulder flexion compared with the CT and TBAT groups. On the FMA, the TBAT group showed higher distal part scores than the CT group. On the SIS, the RBAT group had better strength subscale, physical function domain, and total scores than the CT group.
Limitations.
 This study recruited patients with mild spasticity and without cognitive impairment.(So, they cherry picked the already better off survivors.)
Conclusions.
 Compared with CT, TBAT and RBAT exhibited differential effectson outcome measures. Therapist-based BAT may improve temporal efficiency,smoothness, trunk control, and motor impairment of the distal upper limb. Robot-assisted BAT may improve shoulder flexion and quality of life.
C. Wu, ScD, OTR, Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University,Taoyuan, Taiwan.C. Yang, MS, Department of Occupational Therapy and Gradu-ate Institute of Behavioral Sciences, Chang Gung University.L. Chuang, PT, PhD, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.K. Lin, ScD, OTR, School of Occupational Therapy, College of Medicine, National Taiwan University,and Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation,National Taiwan University Hospi-tal, 17, F4, Xu Zhou Road, Taipei,Taiwan. Address all correspondence to Dr Lin at: kehchunglin@ntu.edu.tw.H. Chen, PhD, Department and Graduate Institute of Industrial Engineering and Management,National Taipei University of Technology, Taipei, Taiwan.M.Chen,PhD,OT,Department of Occupational Therapy and Gradu-ate Institute of Behavioral Sciences, Chang Gung University. W. Huang, MS, Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, En Chu Kong Hospital, NewTaipei City, Taiwan.Ms Yang and Dr Chuang contributed equally to the manuscript.[Wu C, Yang C, Chuang L, et al.Effect of therapist-based versus robot assisted bilateral arm training on motor control, functional performance, and quality of life after chronic stroke: a clinical trial.
Phys Ther.
 2012;92:xxx–xxx.]© 2012 American Physical Therapy AssociationPublished Ahead of Print: April 19, 2012 Accepted: April 11, 2012Submitted: September 2, 2011
Research Report
Post a Rapid Response to this article at:
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Effects of Robot-assisted therapy on upper limb recovery after stroke: A Systematic Review

Interesting that significant improvement in upper limb function but not ADLs.  Ask your hospital EXACTLY what updates to this have occurred in the last 14 years.  You do expect your hospital to be competently following appropriate stroke research? Or are you giving them a pass on their incompetency?

Effects of Robot-assisted therapy on upper limb recovery after stroke: A Systematic Review

Gert Kwakkel, PhD1,2, Boudewijn J. Kollen, PhD3, and Hermano I. Krebs, PhD4,5,6
1 Department Rehabilitation and Research Institute MOVE, VU University Medical Center Amsterdam, The Netherlands 2 Department Rehabilitation, Rudolf Magnus Institute of NeuroScience, University Medical Center Utrecht, The Netherlands 3 Research Bureau, Isala Klinieken Zwolle, The Netherlands 4 Mechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA, USA 5 Department of Neurology and Neuroscience, Burke Institute of Medical Research, Weill Medical College, Cornell University, White Plains, NY, USA 6 Department of Neurology, University of Maryland, School of Medicine, Baltimore, MD, USA

Abstract Background and Purpose— 

To present a systematic review of studies that investigates the effects of robot-assisted therapy on motor and functional recovery in patients with stroke. Summary of Review—A database of articles published up to October 2006 was compiled using the following MEDLINE key words: cerebral vascular accident, cerebral vascular disorders, stroke, paresis, hemiplegia, upper extremity, arm and robot. References listed in relevant publications were also screened. Studies that satisfied the following selection criteria were included: (1) patients were diagnosed with cerebral vascular accident; (2) effects of robot-assisted therapy for the upper limb were investigated; (3) the outcome was measured in terms of motor and/or functional recovery of the upper paretic limb; (4) The study was a randomised clinical trial (RCT). For each outcome measure, the estimated effect size (ES) and the summary effect size (SES) expressed in standard deviation units (SDU) were calculated for motor recovery and functional ability (ADL) using fixed and random effect models. Ten studies, involving 218 patients, were included in the synthesis. Their methodological quality ranged from 4 to 8 on a (maximum) 10 point scale. Meta-analysis showed a non-significant heterogeneous SES in terms of upper limb motor recovery. Sensitivity analysis of studies involving only shoulder-elbow robotics subsequently demonstrated a significant homogeneous SES for motor recovery of the upper paretic limb. No significant SES was observed for functional ability (ADL). 

Conclusion—

As a result of marked heterogeneity in studies between distal and proximal arm robotics, no overall significant effect in favour of robot-assisted therapy was found in the present meta-analysis. However, subsequent sensitivity analysis showed a significant improvement in upper limb motor function after stroke for upper arm robotics. No significant improvement was found in ADL function. However, the administered ADL scales in the reviewed studies fail to adequately reflect recovery of the paretic upper limb and valid instruments that measure outcome of dexterity of the paretic arm and hand are mostly absent in selected studies. Future research on the effects of robot-assisted therapy should therefore distinguish between upper and lower robotics arm training and concentrate on kinematical analysis to differentiate between genuine upper limb motor recovery and functional recovery due to compensation strategies by proximal control of the trunk and upper limb.

Correspondence: G. Kwakkel (PhD), Senior Researcher, Dept. Rehabilitation Medicine, VU University Medical Center, de Boelelaan 1117, 1081 HV Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands, E-mail: g.kwakkel@vumc.nl.

Neuroplastic changes in resting-state functional connectivity after stroke rehabilitation

You'll have to read this yourself.  I am most interested in this statement;

All participants received 5 min of tone(spasticity) normalization for the arm at the beginning of therapy. (Your doctor will need to get that protocol.)

Neuroplastic changes in resting-state functional connectivity after stroke rehabilitation

ORIGINAL RESEARCH
published: 06 October 2015doi: 10.3389/fnhum.2015.00546
Neuroplastic changes in resting-state functional connectivity after stroke rehabilitation
Yang-teng Fan
1†
 , Ching-yi Wu
 2,3†
 , Ho-ling Liu
4,5
 , Keh-chung Lin
1,6
*, Yau-yau Wai
7,8
 and Yao-liang Chen
8
1
School of Occupational Therapy, College of Medicine, National Taiwan University and Division of Occupational Therapy,Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan,
 2
Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
 3
Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan,
 4
Department of Imaging Physics, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA,
5
Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan,
 6
Department of Physical Medicine and Rehabilitation, Division of Occupational Therapy, National Taiwan University Hospital, Taipei, Taiwan,
7
Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Keelung, Taiwan,
 8
MRI Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
 Most neuroimaging research in stroke rehabilitation mainly focuses on the neural mechanisms underlying the natural history of post-stroke recovery.However,connectivity mapping from resting-state fMRI is well suited for different neurological conditions and provides a promising method to explore plastic changes for treatment-induced recovery from stroke. We examined the changes in resting-state functional connectivity (RS-FC) of the ipsilesional primary motor cortex (M1) in 10 post-acute stroke patients before and immediately after 4 weeks of robot-assisted bilateral arm therapy (RBAT). Motor performance, functional use of the affected arm, and daily function improvedin all participants. Reduced interhemispheric RS-FC between the ipsilesional andcontralesional M1 (M1-M1) and the contralesional lateralized connections were noted before treatment. In contrast, greater M1-M1 functional connectivity and disturbed resting-state networks were observed after RBAT relative to pretreatment. Increased changes in M1-M1 RS-FC after RBAT were coupled with better motor and functional improvements. Mediation analysis showed the pre-to-post difference in M1-M1 RS-FC was a significant mediator for the relationship between motor and functional recovery. These results show neuroplastic changes and functional recoveries induced by RBAT in post-acute stroke survivors and suggest that interhemispheric functional connectivity in the motor cortex may be a neurobiological marker for recovery after stroke rehabilitation.
Much more at link until you get to these results.
 

 Results
Clinical Measures
The results of the FMA-UL, WMFT-FAS, and FIM are presented in
 Table 1
. All participants had substantial deficits in motor performance, functional use of the ULs, and daily function before treatment.The results showed that there were significant differences between pretreatment and post-treatment at the corrected level of significance ( p < 0.017) on all clinical measures. The paired Wilcoxon test on the FMA-UL total scores revealed that participants showed significant improvements in levels of motor impairment from pre-treatment to the end of RBAT (Z = 2.82, p = 0.005). Moreover, the WMFT-FAS and FIM data indicatedthat eligible participants had better motor function (Z  = 2.81, p=0.005)andrunctional independence(Z =2.80, p=0.005) after RBAT relative to pre-treatment.
Functional Connectivity Results
The paired Wilcoxon test on the value of the M1-M1 RS-FCshowed that participants had significantly increased M1-M1functional connectivity from pre-treatment to the end of RBAT(Z  = 2.80, p = 0.005). A one sample t-test showed that for the ipsilesional M1pre-treatment, participants had positive RS-FC with the bilateral middle frontal gyrus, bilateral cerebellum, bilateral inferior frontal gyrus, bilateral thalamus, ipsilesional angular gyrus,ipsilesional posterior cingulate cortex, ipsilesional superiorfrontal gyrus, contralesional M1, contralesional caudatenucleus, and contralesional precuneus. Moreover, negativeRS-FC was observed before treatment between the ipsilesionalM1 and the bilateral middle temporal gyrus, ipsilesionalsomatosensory cortex ipsilesional SMA, ipsilesional insula,ipsilesional superior parietal lobule, and contralesional M1(Figure 1A and Table 2). Upon completion of RBAT, positiveRS-FC with the ipsilesional M1 was seen in the bilateralsomatosensory cortex (SI/SII), bilateral posterior cingulatecortex, bilateral cerebellum, bilateral thalamus, ipsilesionalSMA, ipsilesional middle temporal gyrus, contralesional M1,contralesional inferior frontal gyrus, contralesional caudatenucleus, contralesional medial prefrontal cortex, contralesionalanterior cingulate cortex (ACC), and contralesional middlefrontal gyrus. However, participants had negative RS-FCbetween the ipsilesional M1 and the ipsilesional inferior frontalgyrus, ipsilesional middle frontal gyrus, ipsilesional superiorfrontal gyrus, contralesional temporal pole, contralesionalinferior temporal gyrus, and contralesional insula after RBAT(Figure 1B and Table 2).
Figure 2
 shows the maps exhibiting significant differences in RS-FC between pre-treatment and post-treatment. Thesebrain regions are summarized in
 Table 3
. When compared with post-treatment, greater RS-FC of the ipsilesional M1 withcontralesional-lateralized brain regions was observed before treatment (Figure 2A). In contrast, increases in RS-FC were observed between the ipsilesional M1 seed and bilateral medial prefrontal cortex, bilateral M1, bilateral cerebellum,bilateral superior temporal gyrus, ipsilesional middle temporal gyrus, ipsilesional inferior parietal lobule (IPL), ipsilesional SMA, ipsilesional posterior cingulate cortex, ipsilesional SI/SII, ipsilesional caudate nucleus, contralesional ACC, contralesional insula, and contralesional middle occipital gyrus after RBAT relative to pre-treatment (Figure 2B).
Correlation of the RS-FC with Motor and Functional Recovery
Spearman correlation analysis showed that the pre-to-post difference in M1-M1 RS-FC was significantly positively correlated with changes in the WMFT-FAS score (R = 0.79, p = 0.006) and FIM total score (R = 0.92, p < 0.001). Theseindicated that participants with increased M1-M1 RS-FC afterthe intervention had greater gains in functional use of theaffected arm and daily function. However, the relations betweenthe pre-to-post difference M1-M1 connectivity and the changes of FMA-UL score were not significant (R = 0.55, p = 0.09). Mediation Analysis Results
On the basis of a standard three-variable path model with a bootstrap test for the statistical significance of the product a × b, a single-level version of the mediation path model was usedtogetfurther insight of linkage between the clinical measures and RS-FC. Matlab coding implementing mediation analyses, developed by  Wager et al. (2009) is freely available at
2
. In all participants,the change of interhemispheric M1-M1 functional connectivity from pre-treatment to post-treatment was a significant mediatorin predicting the WMFT-FIM relation. The increased change inM1-M1 connectivity was associated with greater improvementsin functional use of the affected arm and daily function after the intervention (a = 1.27, standard error = 0.61, p = 0.044; b = 0.17, standard error=0.057, p=0.021;a×b=0.21,Z =2.03, p=0.042;Figure 3).

Robot-Assisted Stair Climbing Training on Postural Control and Sensory Integration Processes in Chronic Post-stroke Patients: A Randomized Controlled Clinical Trial

Maybe, just maybe your doctor can get this into your rehab since there already is a protocol for this. All she has to do is contact the researchers.  It will never occur.

Robot-Assisted Stair Climbing Training on Postural Control and Sensory Integration Processes in Chronic Post-stroke Patients: A Randomized Controlled Clinical Trial

Marialuisa Gandolfi^1,2*, Nicola Valè^1,2, Eleonora Dimitrova^1,2, Maria Elisabetta Zanolin³, Nicola Mattiuz^1,2, Elisa Battistuzzi^1,2, Marcello Beccari^1,2, Christian Geroin¹, Alessandro Picelli^1,2, Andreas Waldner⁴ and Nicola Smania^1,2

• ¹Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
• ²UOC Neurorehabilitation, AOUI Verona, Verona, Italy
• ³Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
• ⁴Department of Neurological Rehabilitation, Private Hospital Villa Melitta, Bolzano, Italy

Background: Postural control disturbances are one of the important causes of disability in stroke patients affecting balance and mobility. The impairment of sensory input integration from visual, somatosensory and vestibular systems contributes to postural control disorders in post-stroke patients. Robot-assisted gait training may be considered a valuable tool in improving gait and postural control abnormalities.

Objective: The primary aim of the study was to compare the effects of robot-assisted stair climbing training against sensory integration balance training on static and dynamic balance in chronic stroke patients. The secondary aims were to compare the training effects on sensory integration processes and mobility.

Methods: This single-blind, randomized, controlled trial involved 32 chronic stroke outpatients with postural instability. The experimental group (EG, n = 16) received robot-assisted stair climbing training. The control group (n = 16) received sensory integration balance training. Training protocols lasted for 5 weeks (50 min/session, two sessions/week). Before, after, and at 1-month follow-up, a blinded rater evaluated patients using a comprehensive test battery. Primary outcome: Berg Balance Scale (BBS). Secondary outcomes:10-meter walking test, 6-min walking test, Dynamic gait index (DGI), stair climbing test (SCT) up and down, the Time Up and Go, and length of sway and sway area of the Center of Pressure (CoP) assessed using the stabilometric assessment.

Results: There was a non-significant main effect of group on primary and secondary outcomes. A significant Time × Group interaction was measured on 6-min walking test (p = 0.013) and on posturographic outcomes (p = 0.005). Post hoc within-group analysis showed only in the EG a significant reduction of sway area and the CoP length on compliant surface in the eyes-closed and dome conditions.

Conclusion: Postural control disorders in patients with chronic stroke may be ameliorated by robot-assisted stair climbing training and sensory integration balance training. The robot-assisted stair climbing training contributed to improving sensorimotor integration processes on compliant surfaces. Clinical trial registration (NCT03566901).

ROBOT-ASSISTED THERAPY IN UPPER EXTREMITY HEMIPARESIS: OVERVIEW OF AN EVIDENCE-BASED APPROACH

Evidence-based approach is not a protocol so this is still useless. Why are you even doing stroke research if you don't actually help survivors?  Your mentors and senior researchers should be fired for not setting out correct goals for your research.

ROBOT-ASSISTED THERAPY IN UPPER EXTREMITY HEMIPARESIS:OVERVIEW OF AN EVIDENCE-BASED APPROACH

Anne-Gaëlle Grosmaire¹, Christophe Duret^{1, 2*} and Hermano I. Krebs^{3, 4, 5, 6, 7, 8}

• ¹Centre de Rééducation Fonctionnelle Les Trois Soleils, France
• ²Centre Hospitalier Sud Francilien, France
• ³Department of Mechanical Engineering, School of Engineering, Massachusetts Institute of Technology, United States
• ⁴Department of Neurology, University of Maryland School of Medicine, United States
• ⁵Department of Physical Medicine and Rehabilitation, Fujita Health University, Japan
• ⁶Institute of Neuroscience, Newcastle University, United Kingdom
• ⁷Department of Mechanical Science and Bioengineering, Graduate School of Engineering Science, Osaka University, Japan
• ⁸School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, United Kingdom

Robot-mediated therapy is an innovative form of rehabilitation that enables highly repetitive, intensive, adaptive, and quantifiable physical training. It has been increasingly used to restore loss of motor function, mainly in stroke survivors suffering from an upper limb paresis. Multiple studies collated in a growing number of review articles showed the positive effects on motor impairment, less clearly on functional limitations. After describing the current status of robotic therapy after upper limb paresis due to stroke, this overview addresses basic principles related to robotic therapy applied to upper limb paresis. We demonstrate how this innovation is an evidence-based approach in that it meets both the improved clinical and more fundamental knowledge-base about regaining effective motor function after stroke and the need of more objective, flexible and controlled therapeutic paradigms.

Keywords: hemiparesis, rehabilitation robotics, robot-assisted therapy, Upper Extremity, Stroke

Received: 26 Nov 2018; Accepted: 04 Apr 2019.

Edited by:
Bruce H. Dobkin, University of California, Los Angeles, United States

Reviewed by:
Bernhard Sehm, Max Planck Institute for Human Cognitive and Brain Sciences, Germany
Erin Godecke, Edith Cowan University, Australia  

Upper limb robot-assisted rehabilitation versus physical therapy on subacute stroke patients: a follow-up study

Useless without a protocol written up.  Why are you even doing stroke research if you don't actually help survivors?  Your mentors and senior researchers should be fired for not setting out correct goals for your research.

Upper limb robot-assisted rehabilitation versus physical therapy on subacute stroke patients: a follow-up study

MarcoFranceschini^abStefanoMazzoleni^cdMichelaGoffredo^aSanazPournajaf^aDanieleGalafate^aSimoneCriscuolo^aMaurizioAgosti^eFedericoPosteraro^df

https://doi.org/10.1016/j.jbmt.2019.03.016Get rights and content

Abstract

This study aims to analyse the long-term effects (6 months follow-up) of upper limb Robot-assisted Therapy (RT) compared to a Traditional physical Therapy (TT), in subacute stroke patients. Although the literature on upper-limb rehabilitation with robots shows increasing evidence of its effectiveness in stroke survivors, how long the re-learned motor abilities could be maintained over time is still understudied. A randomized controlled follow-up study was conducted on 48 subacute stroke patients who performed the upper-limb therapy using a planar end-effector robotic system (Experimental Group-EG) or TT (Control Group-CG). The clinical assessments were collected at T0 (baseline), T1 (end of treatment) and T2 (6 months follow-up): Upper Limb part of Fugl-Meyer assessment (FM-UL), total passive Range Of Motion (pROM), Modified Ashworth Scale Shoulder (MAS-S) and Elbow (MAS-E). At T1, the intra-group analysis showed significant gain of FM-UL in both EG and CG, while significant improvement in MAS-S, MAS-E, and pROM were found in the EG only. At T2, significant increase in MAS-S were revealed only in the CG. In FM-UL, pROM and MAS-E the improvements obtained at the end of treatment seem to be maintained at 6 months follow-up in both groups. The inter-groups analysis of FM-UL values at T1 and T2 demonstrated significant differences in favour of EG. In conclusion, upper limb Robot-assisted Therapy may lead a greater reduction of motor impairment in subacute stroke patients compared to Traditional Therapy. The gains observed at the end of treatment persisted over time. No serious adverse event related to the study occurred.

Keywords

Robot-assisted Therapy

Follow-up

Rehabilitation

Stroke

Upper Limb

© 2019 Published by Elsevier Ltd.

Boosting robot-assisted rehabilitation of stroke hemiparesis by individualized selection of upper limb movements – a pilot study

Good, then write up a protocol and distribute this to every stroke hospital in the world. OR, figure out a way to get this to everyone of the 10 million yearly stroke survivors. Your choice, DOING NOTHING IS NOT AN OPTION.

Do nothing, get fired.

 

Boosting robot-assisted rehabilitation of stroke hemiparesis by individualized selection of upper limb movements – a pilot study

• Orna RosenthalEmail authorView ORCID ID profile,
• Alan M. Wing,
• Jeremy L. Wyatt,
• David Punt,
• Briony Brownless,
• Chit Ko-Ko and
• R. Christopher Miall

Journal of NeuroEngineering and Rehabilitation201916:42

https://doi.org/10.1186/s12984-019-0513-0

©  The Author(s). 2019

• Received: 27 June 2018
• Accepted: 8 March 2019
• Published: 20 March 2019

Abstract

Background

Intensive robot-assisted training of the upper limb after stroke can reduce motor impairment, even at the chronic stage. However, the effectiveness of practice for recovery depends on the selection of the practised movements. We hypothesized that rehabilitation can be optimized by selecting the movements to be practiced based on the trainee’s performance profile.

Methods

We present a novel principle (‘steepest gradients’) for performance-based selection of movements. The principle is based on mapping motor performance across a workspace and then selecting movements located at regions of the steepest transition between better and worse performance.

To assess the benefit of this principle we compared the effect of 15 sessions of robot-assisted reaching training on upper-limb motor impairment, between two groups of people who have moderate-to-severe chronic upper-limb hemiparesis due to stroke. The test group (N = 7) received steepest gradients-based training, iteratively selected according to the steepest gradients principle with weekly remapping, whereas the control group (N = 9) received a standard “centre-out” reaching training. Training intensity was identical.

Results

Both groups showed improvement in Fugl-Meyer upper-extremity scores (the primary outcome measure). Moreover, the test group showed significantly greater improvement (twofold) compared to control. The score remained elevated, on average, for at least 4 weeks although the additional benefit of the steepest-gradients -based training diminished relative to control.

Conclusions

This study provides a proof of concept for the superior benefit of performance-based selection of practiced movements in reducing upper-limb motor impairment due to stroke. This added benefit was most evident in the short term, suggesting that performance-based steepest-gradients training may be effective in increasing the rate of initial phase of practice-based recovery; we discuss how long-term retention may also be improved.

Trial registration

ISRCTN, ISRCTN65226825, registered 12 June 2018 - Retrospectively registered,

The Combined Effects of Adaptive Control and Virtual Reality on Robot-Assisted Fine Hand Motion Rehabilitation in Chronic Stroke Patients: A Case Study

Once again NO protocols.  You are on your own again to find this out.
http://www.strokejournal.org/article/S1052-3057(17)30437-8/fulltext

Xianwei Huang, PhDCorrespondence information about the author PhD Xianwei HuangEmail the author PhD Xianwei Huang

,

Fazel Naghdy, PhD

,

Golshah Naghdy, PhD

,

Haiping Du, PhD

,

Catherine Todd, PhD

Universality of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia

DOI: http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2017.08.027

Article Info

• Abstract

• Full Text

• Images
• References

Robot-assisted therapy is regarded as an effective and reliable method for the delivery of highly repetitive training that is needed to trigger neuroplasticity following a stroke. However, the lack of fully adaptive assist-as-needed control of the robotic devices and an inadequate immersive virtual environment that can promote active participation during training are obstacles hindering the achievement of better training results with fewer training sessions required. This study thus focuses on these research gaps by combining these 2 key components into a rehabilitation system, with special attention on the rehabilitation of fine hand motion skills. The effectiveness of the proposed system is tested by conducting clinical trials on a chronic stroke patient and verified through clinical evaluation methods by measuring the key kinematic features such as active range of motion (ROM), finger strength, and velocity. By comparing the pretraining and post-training results, the study demonstrates that the proposed method can further enhance the effectiveness of fine hand motion rehabilitation training by improving finger ROM, strength, and coordination.

Key Words:

Stroke rehabilitation, robot assisted therapy, assist-as-needed control, virtual reality, rehabilitation gaming system, clinical assessment

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© 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Robot-assisted post-stroke motion rehabilitation in upper extremities: a survey

But I guess NO protocols. So once again useless research for survivors.
https://www.degruyter.com/view/j/ijdhd.ahead-of-print/ijdhd-2016-0035/ijdhd-2016-0035.xml

Xianwei Huang¹ / Fazel Naghdy² / Golshah Naghdy³ / Haiping Du³ / Catherine Todd⁴

¹School of Electrical, Computer and Telecommunication Engineering (SECTE), University of Wollongong, Australia

²Robotics and Intelligent Systems, SECTE, University of Wollongong, Australia

³SECTE, University of Wollongong, Australia

⁴SECTE, Faculty of Engineering and Information Sciences, University of Wollongong, Australia

Citation Information: International Journal on Disability and Human Development. 20160035, ISSN (Online) 2191-0367, ISSN (Print) 2191-1231, DOI: https://doi.org/10.1515/ijdhd-2016-0035, December 2016

Publication History

Received:

2016-07-14

Accepted:

2016-10-01

Published Online:

2016-12-09

Abstract

Recent neurological research indicates that the impaired motor skills of post-stroke patients can be enhanced and possibly restored through task-oriented repetitive training. This is due to neuroplasticity – the ability of the brain to change through adulthood. Various rehabilitation processes have been developed to take advantage of neuroplasticity to retrain neural pathways and restore or improve motor skills lost as a result of stroke or spinal cord injuries (SCI). Research in this area over the last few decades has resulted in a better understanding of the dynamics of rehabilitation in post-stroke patients and development of auxiliary devices and tools to induce repeated targeted body movements. With the growing number of stroke rehabilitation therapies, the application of robotics within the rehabilitation process has received much attention. As such, numerous mechanical and robot-assisted upper limb and hand function training devices have been proposed. A systematic review of robotic-assisted upper extremity (UE) motion rehabilitation therapies was carried out in this study. The strengths and limitations of each method and its effectiveness in arm and hand function recovery were evaluated. The study provides a comparative analysis of the latest developments and trends in this field, and assists in identifying research gaps and potential future work. (But I guess NO protocols. So once again useless research.)