Objective. The aim of the study was to present a systematic review of studies that investigate the effects of robot-assisted therapy on motor and functional recovery in patients with stroke. Method...

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Effects of Robot-Assisted Therapy on Upper Limb Recovery After Stroke: A Systematic Review

The authors' goal is to apply robotics and automation technology to assist, enhance, quantify, and document neurorehabilitation. This paper reviews a clinical trial involving 20 stroke patients with a prototype robot-aided rehabilitation facility developed at the Massachusetts Institute of Technology, Cambridge, (MIT) and tested at Burke Rehabilitation Hospital, White Plains, NY. It also presents the authors' approach to analyze kinematic data collected in the robot-aided assessment procedure. In particular, they present evidence (1) that robot-aided therapy does not have adverse effects, (2) that patients tolerate the procedure, and (3) that peripheral manipulation of the impaired limb may influence brain recovery. These results are based on standard clinical assessment procedures. The authors also present one approach using kinematic data in a robot-aided assessment procedure.

/pdf/robot-aided-neurorehabilitation-2u069301n4.pdf

Robot-aided neurorehabilitation

Classen, Joseph, Joachim Liepert, Steven P. Wise, Mark Hallett, and Leonardo G. Cohen. Rapid plasticity of human cortical movement representation induced by practice. J. Neurophysiol. 79: 1117–1123...

Rapid Plasticity of Human Cortical Movement Representation Induced by Practice

Purpose of reviewMuch of neurorehabilitation rests on the assumption that patients can improve with practice. This review will focus on arm movements and address the following questions: (i) What is motor learning? (ii) Do patients with hemiparesis have a learning deficit? (iii) Is recovery after in

https://www.jsmf.org/meetings/2008/may/Krakauer_COIN(2006).pdf

Motor learning: its relevance to stroke recovery and neurorehabilitation.

Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke.

Repetitive training of isolated movements improves the outcome of motor rehabilitation of the centrally paretic hand

Motor learning after recovery from hemiparesis

https://www.archives-pmr.org/article/S0003-9993(99)90137-5/pdf

Testing a motor performance series and a kinematic motion analysis as measures of performance in high-functioning stroke patients: Reliability, validity, and responsiveness to therapeutic intervention

Purpose: The Arm Ability Training improves motor function among stroke and traumatic brain injury patients with mild arm paresis. There is, however, a considerable variability in motor recovery among patients receiving the Arm Ability Training. The study investigated whether psychological variables can explain the variability in motor recovery. Methods: In a sample of 33 patients receiving the Arm Ability Training both motor performance (by use of the standardised arm function test TEMPA) and cognitive functions (attention, perceptual abilities, and learning) as well as depression were assessed before training was commenced. Both univariate correlational analyses and stepwise multiple regression were used to investigate these variables' ability to predict motor improvement (TEMPA difference scores from pre to post test after 3 weeks). Results: The degree of motor dysfunction of the affected arm explained most (70%) of the variance of motor improvement scores of the standardised arm function test (TEMPA). Psychometric scores showed no or at the most weak associations with motor improvement (explaining at the most 10% of the variance). Conclusions: Psychological variables had not been critical modifiers of motor recovery among stroke and traumatic brain injury patients with mild arm paresis receiving the Arm Ability Training.

Do psychological variables modify motor recovery among patients with mild arm paresis after stroke or traumatic brain injury who receive the Arm Ability Training

Background: Limiting the ability to engage in social interaction, aphasia increases the risk of poststroke depression and may prevent classical forms of psychotherapy. Our parallel-group, blinded-assessment, quasi-randomized controlled trial explores the feasibility and potential efficacy of intensive social interaction as a means to alleviate poststroke depression in subacute aphasia. Methods: We adopted a linguistically validated treatment program based on massed practice and conversational turn-taking (Intensive Language-Action Therapy). In a routine outpatient setting, 60 individuals with poststroke depression and subacute aphasia (0.5–6 months following left-hemispheric ischemia or hemorrhage) were assigned to Intensive Language-Action Therapy combined with standard care (Group I) or standard care alone (Group II). End points included feasibility (primary outcome) alongside change on self-report and clinician-rated measures of depression severity (co-primary outcomes: Beck’s Depression Inventory; Hamilton Rating Scale for Depression) after a 1-month treatment period (5 weekly 1-hour sessions), controlled for progress in language performance (secondary outcome: Aachen Aphasia Test, AAT). Results: 100% treatment participation demonstrated feasibility of Intensive Language-Action Therapy in poststroke depression. Analyses (n=60) revealed significant between-group differences on the Beck’s Depression Inventory (change in Group I [95% CI]: −12.6 [±4.9]; in Group II: −5.8 [±3.2]; P=0.040) and Hamilton Rating Scale for Depression (change in Group I: −5.0 [±1.4]; in Group II: −3.3 [±1.2]; P=0.002), indicating small-to-medium effect sizes in reducing depression severity with Intensive Language-Action Therapy (η2≤0.101). No significant between-group differences emerged on expressive AAT subscales. Conclusions: Our results confirm the feasibility and potential efficacy of intensive social interaction for treatment of poststroke depression in subacute aphasia. Registration: URL: www.clinicaltrials.gov; Unique identifier: NCT04318951.

Petra Denzler

Papers

Repetitive training of isolated movements improves the outcome of motor rehabilitation of the centrally paretic hand

Motor learning after recovery from hemiparesis

Testing a motor performance series and a kinematic motion analysis as measures of performance in high-functioning stroke patients: Reliability, validity, and responsiveness to therapeutic intervention

Do psychological variables modify motor recovery among patients with mild arm paresis after stroke or traumatic brain injury who receive the Arm Ability Training

Intensive Social Interaction for Treatment of Poststroke Depression in Subacute Aphasia: The CONNECT Trial