A Pilot Study: An Innovative End-effector Haptic Device Applied in Subacute and Chronic Stroke Patients

Введение

Stroke is currently the leading cause of long-term disability and is often associated with functional impairment of the upper limbs, which is generally more common than that of the lower limbs. Motor dysfunction of the upper limbs is often associated with other neurological symptoms that hinder the recovery of motor function and therefore requires systematic and professional therapeutic intervention.

The main goal of stroke rehabilitation is to promote functional recovery of the damaged limb to maximize functional outcomes and improve quality of life. Studies have shown that providing high-intensity therapy and task-specific exercise training combined with robotic and traditional rehabilitation programs can achieve better results. Recent studies have shown that the use of robotics in rehabilitation therapy is well-accepted and well-tolerated in patients with chronic stroke. The current analysis of the mechanism of motor recovery in stroke patients is only based on clinical outcome measures, while the robotic system can provide different biomechanical data records, such as speed, strength, etc., which can be used to analyze and evaluate the recovery of stroke patients.

The main purpose of this study is to evaluate the effects of upper limb robot-assisted rehabilitation on motor recovery in stroke patients who underwent treatment based on a haptic device.

Methods

A total of 39 stroke patients (23 subacute and 16 chronic) underwent rehabilitation training by using the novel end-traction upper limb rehabilitation robot. For comparison, 13 healthy subjects were recruited.

The following clinical outcome measures were used: Chedoke-McMaster Stroke Assessment (CMSA), Modified Ashworth Scale (Modified Ashworth Scale, modified Ashworth Scale), and Modified Ashworth Scale (Modified Ashworth Scale, modified Ashworth Scale) were used to evaluate stroke severity. MAS), Fugl-Meyer Assessment Upper Extremity Scale (FMA-UE), Medical Research Council (MRC) method, Medical Research Council (MRC) method, Fugl-Meyer Assessment Upper Extremity Scale (FMA-UE). MRC), Motricity Index (MI), Box and Block test (B&B) and modified Barthel index (MBI).

The following parameters were calculated: mean velocity, maximum velocity, meantime, path length, standardized jitter, mean force, mean error, mean energy expenditure, and percentage of active patient-robot interactions. Assessments were performed before and after treatment.

Results

In Table 3, thirty-nine stroke patients (twenty-three subacute and sixteen chronic) underwent rehabilitation training by using MOTORE/Armotion haptic system. Thirteen healthy subjects were recruited for comparison purposes. The following clinical outcome measures were used: Chedoke-McMaster Stroke Assessment, Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FM), Medical Research Council, Motricity Index (MI), Box and Block Test (B&B) and Modified Barthel Index (mBI). The following parameters were computed: mean speed, maximum speed, meantime, path length, normalized jerk, mean force, mean error, mean energy expenditure and active patient-robot interaction percentage. The assessments were carried-out before and after treatment.

Fig. 4-6 show the results of the kinematic analysis: significant changes in mean velocity were observed in both groups (Fig.4) : In particular, at the end of the treatment, patients were able to perform the reaching task at a higher speed than at the beginning of the rehabilitation treatment. The maximum velocity and path length (Fig.4) did not change significantly in either group. Significant changes in mean time (Fig.4), mean force, and mean energy expenditure (Fig.5) were observed in the subacute group; Finally, in the subacute group, the percentage of positive patient-robot interactions increased significantly at the end of robot-assisted therapy, as shown in Fig.6.

Conclusions

In both subacute and chronic patients, the innovative haptic device used is at least as effective as an existing device used in similar studies. However, compared to similar haptic devices, the advantages of the novel device are its lightweight, smaller size, and portability, thus having the potential for use in the home.

Based on the above research background, Syrebo has developed the portable upper limb rehabilitation robot, SY-UEA2, providing a new upper limb rehabilitation method and a more reliable rehabilitation option for the majority of patients.

Syrebo upper limb rehabilitation robot adopts a full-featured mobile chassis and high-precision optical positioning technology, providing users with various effective target-oriented training to enhance upper limb strength, speed, and accuracy, and reshape upper limb functionality.

Compared with the traditional upper limb rehabilitation training method, SY-UEA2 adopts advanced motion control technology and high-precision optical positioning sensor technology, which can realize the positioning error <0.03mm, accurately captures the patient's movement state and carries out intelligent movement rehabilitation training according to rehabilitation needs. At the same time, it has five advantages, such as integration of training and evaluation, task-oriented scenario interaction, full-cycle coverage of rehabilitation, multi-dimensional synchronous training and multiple safety protection.

 

Reference: Mazzoleni S, Battini E, Crecchi R, et al. Upper limb robot-assisted therapy in subacute and chronic stroke patients using an innovative end-effector haptic device: A pilot study. NeuroRehabilitation. 2018;42(1):43-52.