title: Robot-supported upper limb training in a virtual learning environment : a pilot randomized controlled trial in persons with MS.
abstract: BACKGROUND
  Despite the functional impact of upper limb dysfunction in multiple sclerosis (MS), effects of intensive exercise programs and specifically robot-supported training have been rarely investigated in persons with advanced MS.
  
  
  OBJECTIVE
  To investigate the effects of additional robot-supported upper limb training in persons with MS compared to conventional treatment only.
  
  
  METHODS
  Seventeen persons with MS (pwMS) (median Expanded Disability Status Scale of 8, range 3.5-8.5) were included in a pilot RCT comparing the effects of additional robot-supported training to conventional treatment only. Additional training consisted of 3 weekly sessions of 30 min interacting with the HapticMaster robot within an individualised virtual learning environment (I-TRAVLE). Clinical measures at body function (Hand grip strength, Motricity Index, Fugl-Meyer) and activity (Action Research Arm test, Motor Activity Log) level were administered before and after an intervention period of 8 weeks. The intervention group were also evaluated on robot-mediated movement tasks in three dimensions, providing active range of motion, movement duration and speed and hand-path ratio as indication of movement efficiency in the spatial domain. Non-parametric statistics were applied.
  
  
  RESULTS
  PwMS commented favourably on the robot-supported virtual learning environment and reported functional training effects in daily life. Movement tasks in three dimensions, measured with the robot, were performed in less time and for the transporting and reaching movement tasks more efficiently. There were however no significant changes for any clinical measure in neither intervention nor control group although observational analyses of the included cases indicated large improvements on the Fugl-Meyer in persons with more marked upper limb dysfunction.
  
  
  CONCLUSIONS
  Robot-supported training lead to more efficient movement execution which was however, on group level, not reflected by significant changes on standard clinical tests. Persons with more marked upper limb dysfunction may benefit most from additional robot-supported training, but larger studies are needed.
  
  
  BACKGROUND
  This trial is registered within the registry Clinical Trials GOV ( NCT02257606 ).
authors.affiliation: REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3590, Diepenbeek, Belgium. peter.feys@uhasselt.be.
authors.forename: Peter
authors.initials: P
authors.lastname: Feys
authors.affiliation: Expertise Centre for Digital Media - tUL - iMinds, Hasselt University, Wetenschapspark 2, 3590, Diepenbeek, Belgium. karin.coninx@uhasselt.be.
authors.forename: Karin
authors.initials: K
authors.lastname: Coninx
authors.affiliation: Rehabilitation and MS Center Overpelt, 3900, Overpelt, Belgium. lore.kerkhofs@msreva.be.
authors.forename: Lore
authors.initials: L
authors.lastname: Kerkhofs
authors.affiliation: Expertise Centre for Digital Media - tUL - iMinds, Hasselt University, Wetenschapspark 2, 3590, Diepenbeek, Belgium. tom.deweyer@uhasselt.be.
authors.forename: Tom
authors.initials: T
authors.lastname: De Weyer
authors.affiliation: Rehabilitation and MS Center Overpelt, 3900, Overpelt, Belgium. veronik.truyens@msreva.be.
authors.forename: Veronik
authors.initials: V
authors.lastname: Truyens
authors.affiliation: REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3590, Diepenbeek, Belgium. anneleen.maris@uhasselt.be.
authors.forename: Anneleen
authors.initials: A
authors.lastname: Maris
authors.affiliation: REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3590, Diepenbeek, Belgium. ilse.lamers@uhasselt.be.
authors.forename: Ilse
authors.initials: I
authors.lastname: Lamers
mesh_terms: D000368:Aged; D001132:Arm / Q000503:physiopathology; D004185:Disability Evaluation; D005260:Female; D006225:Hand / Q000503:physiopathology; D018737:Hand Strength; D006801:Humans; D007858:Learning; D017770:Lifting; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D011597:Psychomotor Performance; D012371:Robotics; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*; D014584:User-Computer Interface