A proof of concept study for the integration of robot therapy with physiotherapy in the treatment of stroke patients.
OBJECTIVE
To carry out a proof of concept study for integrating robot therapy with physiotherapy in the treatment of stroke patients.


METHODS
A simple and 'gentle' paradigm of robot-patient interaction was designed in order to foster the re-emergence of smooth, active control patterns in coordinated shoulder/elbow reaching movements. A haptic robot was programmed according to a strategy of minimal, progressively reduced assistance, with a double representation of targets: (i) visual (circles on a screen) and (ii) haptic (robot-generated force fields). The protocol included trials with and without vision, in order to emphasize the role of proprioceptive feedback. The training paradigm included 10 sessions and more than 5000 movements.


METHODS
Ten chronic, hemiparetic subjects; four controls provided reference values for the performance measurements.


METHODS
Four performance indicators (derived from the analysis of the reaching trajectories); clinical/functional measures (Fugl-Meyer and Ashworth scales).


RESULTS
After robot therapy reaching movements became faster and smoother. The performance in the no-vision trials was at least as good as in the vision trials. The Fugl-Meyer arm scores also increased significantly and remained approximately constant at follow-up; the Ashworth scores did not change.


CONCLUSIONS
In spite of its simplicity, a limited number of ;gentle' robot therapy sessions appear to be beneficial, even for severely impaired patients, although no firm conclusion can be drawn at this point. However, the study provides support material for the careful design of controlled clinical trials and for a better integration with physiotherapy.
Casadio
Maura
M
Neurolab, Department of Informatics, Systems and Telematics (DIST), University of Genova, Genova, Italy.
Giannoni
Psiche
P
Morasso
Pietro
P
Sanguineti
Vittorio
V
D000328:Adult; D000368:Aged; D003210:Concept Formation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D017063:Outcome Assessment, Health Care; D010291:Paresis / Q000209:etiology / Q000523:psychology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D020127:Recovery of Function; D012371:Robotics; D020521:Stroke / Q000150:complications / Q000523:psychology; D000071939:Stroke Rehabilitation; D013647:Task Performance and Analysis; D034941:Upper Extremity / Q000503:physiopathology