NDLI: Pattern of improvement in upper limb pointing task kinematics after a 3-month training program with robotic assistance in stroke

Content Provider	Springer Nature : BioMed Central
Author	Pila, Ophélie Duret, Christophe Laborne, François-Xavier Gracies, Jean-Michel Bayle, Nicolas Hutin, Emilie
Abstract	Background When exploring changes in upper limb kinematics and motor impairment associated with motor recovery in subacute post stroke during intensive therapies involving robot-assisted training, it is not known whether trained joints improve before non-trained joints and whether target reaching capacity improves before movement accuracy. Methods Twenty-two subacute stroke patients (mean delay post-stroke at program onset 63 ± 29 days, M2) underwent 50 ± 17 (mean ± SD) 45-min sessions of robot-assisted (InMotion™) shoulder/elbow training over 3 months, in addition to conventional occupational therapy. Monthly evaluations (M2 to M5) included Fugl-Meyer Assessment (FM), with subscores per joint, and four robot-based kinematic measures: mean target distance covered, mean velocity, direction accuracy (inverse of root mean square error from straight line) and movement smoothness (inverse of mean number of zero-crossings in the velocity profile). We assessed delays to reach statistically significant improvement for each outcome measure. Results At M5, all clinical and kinematic parameters had markedly improved: Fugl-Meyer, +65% (median); distance covered, +87%; mean velocity, +101%; accuracy, +134%; and smoothness, +96%. Delays to reach statistical significance were M3 for the shoulder/elbow Fugl-Meyer subscore (+43%), M4 for the hand (+80%) and M5 for the wrist (+133%) subscores. For kinematic parameters, delays to significant improvements were M3 for distance (+68%), velocity (+65%) and smoothness (+50%), and M5 for accuracy (+134%). Conclusions An intensive rehabilitation program combining robot-assisted shoulder/elbow training and conventional occupational therapy was associated with improvement in shoulder and elbow movements first, which suggests focal behavior-related brain plasticity. Findings also suggested that recovery of movement quantity related parameters (range of motion, velocity and smoothness) might precede that of movement quality (accuracy). Trial registration EudraCT 2016–005121-36 . Date of Registration: 2016–12-20. Date of enrolment of the first participant to the trial: 2009–11-24 (retrospective data).
Related Links	https://jneuroengrehab.biomedcentral.com/counter/pdf/10.1186/s12984-017-0315-1.pdf
Ending Page	10
Page Count	10
Starting Page	1
File Format	HTM / HTML
ISSN	17430003
DOI	10.1186/s12984-017-0315-1
Journal	Journal of NeuroEngineering and Rehabilitation
Issue Number	1
Volume Number	14
Language	English
Publisher	BioMed Central
Publisher Date	2017-10-13
Access Restriction	Open
Subject Keyword	Neurosciences Neurology Rehabilitation Medicine Biomedical Engineering and Bioengineering Hemiparesis Subacute stroke Prolonged robot-assisted training High intensity Repetitive active movements
Content Type	Text
Resource Type	Article
Subject	Health Informatics Rehabilitation
Journal Impact Factor	5.2/2023
5-Year Journal Impact Factor	5.6/2023

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