title: Adaptive robot training for the treatment of incoordination in Multiple Sclerosis.
abstract: BACKGROUND
  Cerebellar symptoms are extremely disabling and are common in Multiple Sclerosis (MS) subjects. In this feasibility study, we developed and tested a robot therapy protocol, aimed at the rehabilitation of incoordination in MS subjects.
  
  
  METHODS
  Eight subjects with clinically defined MS performed planar reaching movements while grasping the handle of a robotic manipulandum, which generated forces that either reduced (error-reducing, ER) or enhanced (error-enhancing, EE) the curvature of their movements, assessed at the beginning of each session. The protocol was designed to adapt to the individual subjects' impairments, as well as to improvements between sessions (if any). Each subject went through a total of eight training sessions. To compare the effect of the two variants of the training protocol (ER and EE), we used a cross-over design consisting of two blocks of sessions (four ER and four EE; 2 sessions/week), separated by a 2-weeks rest period. The order of application of ER and EE exercises was randomized across subjects. The primary outcome measure was the modification of the Nine Hole Peg Test (NHPT) score. Other clinical scales and movement kinematics were taken as secondary outcomes.
  
  
  RESULTS
  Most subjects revealed a preserved ability to adapt to the robot-generated forces. No significant differences were observed in EE and ER training. However over sessions, subjects exhibited an average 24% decrease in their NHPT score. The other clinical scales showed small improvements for at least some of the subjects. After training, movements became smoother, and their curvature decreased significantly over sessions.
  
  
  CONCLUSIONS
  The results point to an improved coordination over sessions and suggest a potential benefit of a short-term, customized, and adaptive robot therapy for MS subjects.
authors.affiliation: University of Genoa, Department of Informatics, Systems and Telecommunications, Via Opera Pia 13, Genoa, Italy. elena.vergaro@unige.it
authors.forename: Elena
authors.initials: E
authors.lastname: Vergaro
authors.forename: Valentina
authors.initials: V
authors.lastname: Squeri
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Brichetto
authors.forename: Maura
authors.initials: M
authors.lastname: Casadio
authors.forename: Pietro
authors.initials: P
authors.lastname: Morasso
authors.forename: Claudio
authors.initials: C
authors.lastname: Solaro
authors.forename: Vittorio
authors.initials: V
authors.lastname: Sanguineti
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001132:Arm / Q000503:physiopathology; D001259:Ataxia / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D001696:Biomechanical Phenomena; D018592:Cross-Over Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D020528:Multiple Sclerosis, Chronic Progressive / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D009483:Neuropsychological Tests; D011214:Practice, Psychological; D012371:Robotics / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome