title: A new treatment in the rehabilitation of the paretic upper limb after stroke: the ARAMIS prototype and treatment protocol.
abstract: BACKGROUND
  In recent years, as part of the rehabilitation of post stroke patients, the use of robotic technologies to improve recovery of upper limb has become more widespread. The Automatic Recovery Arm Motility Integrated System (ARAMIS) is a concept robot and prototype designed to promote the functional interaction of the arms in the neurorehabilitation of the paretic upper limb. Two computer-controlled, symmetric and interacting exoskeletons compensate for the inadequate strength and accuracy of the paretic arm and the effect of gravity during rehabilitation. Rehabilitation is possible in 3 different modalities; asynchronous, synchronous and active-assisted.
  
  
  OBJECTIVE
  To compare the effectiveness of robotic rehabilitation by an exoskeleton prototype system with traditional rehabilitation in motor and functional recovery of the upper limb after stroke.
  
  
  METHODS
  Case-control study, 52 patients enrolled in the study, 28 cases (women: 8, age: 65 ± 10 yrs) treated with ARAMIS and 24 controls (women: 11, age: 69 ± 7 yrs) with conventional rehabilitation. Motor impairment assessed before and after treatment with Fugl-Meyer scale and Motricity Index, level of disability assessed with the Functional Independence Measure. A questionnaire was also administered to assess the patient's tolerance to robotic therapy.
  
  
  RESULTS
  After 28 ± 4 sessions over a 54 ± 3.6-day period, the patients treated by ARAMIS had an improvement on the Fugl-Meyer scale (global score from 43 ± 18 to 73 ± 29; p < 0.00001), Motricity Index scale (p < 0.004) and Functional Independence Measure (p < 0.001). A lesser degree of improvement was achieved using conventional rehabilitation, the Fugl-Meyer global score of the control group improved from 41 ± 13 to 58 ± 16 (p < 0.006) and the motor function item from 9.4 ± 4.1 to 14.9 ± 5.8 (p < 0.023).
  
  
  CONCLUSIONS
  Motor improvement was greater at the wrist and hand than at shoulder and elbow level in patients treated by ARAMIS and controls, but it was significantly greater in ARAMIS-treated patients than in controls. The results indicate a greater efficacy of ARAMIS compared to conventional rehabilitation.
authors.affiliation: RAN, Ricerca Avanzata in Neuroriabilitazione, Istituto S. Anna, Crotone, Italy.
authors.forename: Loris
authors.initials: L
authors.lastname: Pignolo
authors.affiliation: RAN, Ricerca Avanzata in Neuroriabilitazione, Istituto S. Anna, Crotone, Italy.
authors.forename: Lucia F
authors.initials: LF
authors.lastname: Lucca
authors.affiliation: RAN, Ricerca Avanzata in Neuroriabilitazione, Istituto S. Anna, Crotone, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Basta
authors.affiliation: RAN, Ricerca Avanzata in Neuroriabilitazione, Istituto S. Anna, Crotone, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Serra
authors.affiliation: RAN, Ricerca Avanzata in Neuroriabilitazione, Istituto S. Anna, Crotone, Italy.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Pugliese
authors.affiliation: Dipartimento di Neuroscienze, Oftalmologia e Genetica, Università degli Studi di Genova, Genoa, Italy.
authors.forename: Walter G
authors.initials: WG
authors.lastname: Sannita
authors.affiliation: RAN, Ricerca Avanzata in Neuroriabilitazione, Istituto S. Anna, Crotone, Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Dolce
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D002985:Clinical Protocols; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000209:etiology / Q000534:rehabilitation*; D020127:Recovery of Function; D012371:Robotics; D000071939:Stroke Rehabilitation / Q000379:methods*; D016896:Treatment Outcome; D034941:Upper Extremity