Use of Robotics to Improve Upper Extremity Function in Adults with Neurological Conditions

Objectives of Presentation: 1. Describe the impact of robotics on upper extremity function among various neurological populations. 2. Differentiate which patients are appropriate for robotics interventions for upper extremity rehabiliation. 3. Defend the feasibility of robotic interventions for upper extremity rehabilitation of neurological populations. PICO: To what extend does robotic-assisted therapy improve UE function in adults with neurological conditions? Note: Handout with references available at bottom of page. Presentation: 37:3

Hemodynamic changes in Protocol 2.

<p>Values are mean ± SEM; n = 6–7. Abbreviations: MABP (mm Hg), mean arterial blood pressure; HR (beats/min), heart rate; ND-CIR, non-diabetic control ischemia/reperfusion; ND-RIPerc, non-diabeic remote ischemic perconditioning; DM-CIR: diabetes mellitus control ischemia/reperfusion; DM-RIPerc, diabetes mellitus remote perconditioning.</p><p>*<i>P</i><0.05 vs. ND-CIR.</p

The effect of RIPerc on eNOS expression and peroxynitrite formation.

<p>(A and C) Effect of remote ischemic perconditioning (RIPerc) on phosphorylated of eNOS at Ser1177 (p-eNOS), total eNOS and nitrotyrosine (3NT) in protocol 1. (B) Effect of RIPerc on NOS expression in non-diabetic and diabetic rats of protocol 2. Values are means ± SEM; n = 5–8. *<i>P</i><0.05 vs. CIR.</p

Myocardial area at risk and infarct size.

<p>Area at risk (A and B) expressed as % of left ventricle and infarct size (C and D) expressed as % of the area at risk following 30 min ischemia and 2 hrs reperfusion in rats included in protocol 1 (A and C) and in non-diabetic and diabetic rats included in protocol 2 (B and D). Values are means ± SEM; n = 6–10. **<i>P</i><0.01, ***<i>P</i><0.001 vs. CIR; ^###<i>P</i><0.001 vs. RIPerc and ^†††<i>P</i><0.001 vs. ND-CIR.</p

ROCK activity expressed as a phosphorylation of ezrin following ischemia/reperfusion.

<p>(A) Effect of the peroxynitrite decomposition catalyst FeTPPS, the ROCK inhibitor hydroxyfasudil (H.fasudil), remote ischemic preconditioning (RIPerc) and RIPerc+the NOS inhibitor L-NMMA in protocol 1. (B and C) Effect of RIPerC in non-diabetic and diabetic rats of protocol 2. Values are means ± SEM; n = 5–7. ***<i>P</i><0.001 vs. CIR; ^###<i>P</i><0.001 vs. RIPerc and ^††<i>P</i><0.01 vs. ND-CIR.</p

Experimental protocols.

<p>The animals were subjected to 40 min of ischemia and 240 min reperfusion. The groups were randomized to vehicle ic, nor-NOHA ic, nor-NOHA combined with L-NMMA ic or nor-NOHA iv. All infusions were started at 30 min of ischemia except L-NMMA which was started at 25 min of ischemia. The infusions were maintained until 5 min of reperfusion.</p

Expression of arginase II in the cytosolic and mitochondrial fractions of a representative myocardial sample.

<p>For comparison the expression of the mitochondrial membrane protein cytochrome oxidase (COX) is depicted.</p

Representative blots (upper panel) and quantitative analysis of the expression (lower panel) of arginase I in the cytosolic fraction (A) and arginase II in the mitochondrial fraction (B) of myocardial samples from the non-ischemic and ischemic area of pigs subjected to ischemia-reperfusion and myocardium from sham operated pigs.

<p>Expression of arginase I is normalized to that of the surface membrane L-type Ca²⁺channel, dihydropyridine receptor (DHPR) and arginase II to that of cytochrome oxidase (COX) and presented in % of the mean expression in the sham group. Mean±SEM, n = 6. There were no significant differences between the groups.</p

Area at risk (A), infarct size (B) and representative triphenyltetrazolium chloride stained cross section of the left ventricle (C) of the groups given ic vehicle, the arginase inhibitor nor-NOHA, the combination of the NOS-inhibitor L-NMMA and nor-NOHA, or iv administration of nor-NOHA.

<p>Mean and SEM; n = 5–7. Significant difference from the vehicle group is indicated; **P<0.01.</p

Arginase activity in myocardial samples from ischemic and non-ischemic myocardium of pigs subjected to ischemia-reperfusion and myocardium from sham operated pigs.

<p>Mean±SEM, n = 6–7. *P<0.05, **P<0.01.</p