Applicability of an electrical resistance modulator device in the rehabilitation of a person with spinal cord injury

INTRODUCTION: Technology is in rapid and continuous evolution. The recovery of functions, motor, and cognitive activities benefits from it to define new outcome measures and new rehabilitation processes. This study evaluates the applicability of an electrical resistance modulator device for rehabilitation purposes for a person with spinal cord injury. MATERIALS AND METHODS: The study sample consisted of 10 healthy, able-bodied subjects assessed in a light wheelchair. A resistance training mode is compared using the electrical resistance modulator device and a standard strength training protocol with the aid of two weights, through an electromyographic and a kinematic evaluation with a triaxial accelerometer. The movements investigated consist of arm abduction-adduction, arm elevation-extension and elbow flexion-extension. RESULTS AND DISCUSSION: In the flexion-extension gesture of the arm, there is a greater symmetry of muscle activation and less activation of the muscles not directly involved in the movement during the use of the electrical resistance modulator device. In the flexion-extension of the elbow and flexion-extension of the shoulder, the muscle power expressed through the electrical device is greater, while in the abduction-adduction of the shoulder, it is more significant with weights. For the joint Range of Motion, the duration of the motion cycles and their symmetry, there are no significant differences between the two experimental conditions. CONCLUSIONS: The study results confirm that training for increasing muscle strength in a person with spinal cord injury can be performed using the electrical resistance modulator device. There are no contraindications to its use nor greater risks for the subject’s health. Further studies are needed to investigate the benefits of using the electrical device in the early stages of rehabilitation of a person with spinal cord injury

Robot-assisted gait training in patients with Parkinson's disease: Implications for clinical practice. A systematic review

none36Background: Gait impairments are common disabling symptoms of Parkinson's disease (PD). Among the approaches for gait rehabilitation, interest in robotic devices has grown in recent years. However, the effectiveness compared to other interventions, the optimum amount of training, the type of device, and which patients might benefit most remains unclear. Objective: To conduct a systematic review about the effects on gait of robot-assisted gait training (RAGT) in PD patients and to provide advice for clinical practice. Methods: A search was performed on PubMed, Scopus, PEDro, Cochrane library,Web of science, and guideline databases,following PRISMA guidelines.We included English articles if they used a robotic system with details about the intervention, the parameters, and the outcome measures. We evaluated the level and quality of evidence. Results: We included twenty papers out of 230 results: two systematic reviews, 9 randomized controlled trials, 4 uncontrolled studies, and 5 descriptive reports. Nine studies used an exoskeleton device and the remainders end-effector robots, with large variability in terms of subjects' disease-related disability. Conclusions: RAGT showed benefits on gait and no adverse events were recorded. However, it does not seem superior to other interventions, except in patients with more severe symptoms and advanced disease.noneCarmignano, Simona Maria; Fundaro', Cira; Bonaiuti, Donatella; Calabro', Rocco Salvatore; Cassio, Anna; Mazzoli, Davide; Bizzarini, Emiliana; Campanini, Isabella; Cerulli, Simona; Chisari, Carmelo; Colombo, Valentina; Dalise, Stefania; Gazzotti, Valeria; Mazzoleni, Daniele; Mazzucchelli, Miryam; Melegari, Corrado; Merlo, Andrea; Stampacchia, Giulia; Boldrini, Paolo; Mazzoleni, Stefano; Posteraro, Federico; Benanti, Paolo; Castelli, Enrico; Draicchio, Francesco; Falabella, Vincenzo; Galeri, Silvia; Gimigliano, Francesca; Grigioni, Mauro; Mazzon, Stefano; Molteni, Franco; Morone, Giovanni; Petrarca, Maurizio; Picelli, Alessandro; Senatore, Michele; Turchetti, Giuseppe; Andrenelli, ElisaCarmignano, Simona Maria; Fundaro', Cira; Bonaiuti, Donatella; Calabro', Rocco Salvatore; Cassio, Anna; Mazzoli, Davide; Bizzarini, Emiliana; Campanini, Isabella; Cerulli, Simona; Chisari, Carmelo; Colombo, Valentina; Dalise, Stefania; Gazzotti, Valeria; Mazzoleni, Daniele; Mazzucchelli, Miryam; Melegari, Corrado; Merlo, Andrea; Stampacchia, Giulia; Boldrini, Paolo; Mazzoleni, Stefano; Posteraro, Federico; Benanti, Paolo; Castelli, Enrico; Draicchio, Francesco; Falabella, Vincenzo; Galeri, Silvia; Gimigliano, Francesca; Grigioni, Mauro; Mazzon, Stefano; Molteni, Franco; Morone, Giovanni; Petrarca, Maurizio; Picelli, Alessandro; Senatore, Michele; Turchetti, Giuseppe; Andrenelli, Elis

Evidence-based improvement of gait in post-stroke patients following robot-assisted training: A systematic review

Background: The recovery of walking after stroke is a priority goal for recovering autonomy. In the last years robotic systems employed for Robotic Assisted Gait Training (RAGT) were developed. However, literature and clinical practice did not offer standardized RAGT protocol or pattern of evaluation scales. Objective: This systematic review aimed to summarize the available evidence on the use of RAGT in post-stroke, following the CICERONE Consensus indications. Methods: The literature search was conducted on Pubmed, Cochrane library and PEDro, including studies with the following criteria: 1) adult post-stroke survivors with gait disability in acute/subacute/chronic phase; 2) RAGT as intervention; 3) any comparators; 4) outcome regarding impairment, activity, and participation; 5) both primary studies and reviews. Results: Sixty-one articles were selected. Data about characteristics of patients, level of disability, robotic devices used, RAGT protocols, outcome measures, and level of evidence were extracted. Conclusion: It is possible to identify robotic devices that are more suitable for specific phase disease and level of disability, but we identified significant variability in dose and protocols. RAGT as an add-on treatment seemed to be prevalent. Further studies are needed to investigate the outcomes achieved as a function of RAGT doses delivered

Robotic-assisted gait rehabilitation following stroke: a systematic review of current guidelines and practical clinical recommendations

INTRODUCTION: Stroke is the third leading cause of adult disability worldwide, and lower extremity motor impairment is one of the major determinants of long-term disability. Although robotic therapy is becoming more and more utilized in research protocols for lower limb stroke rehabilitation, the gap between research evidence and its use in clinical practice is still significant. The aim of this study was to determine the scope, quality, and consistency of guidelines for robotic lower limb rehabilitation after stroke, in order to provide clinical recommendations.EVIDENCE ACQUISITION: We systematically reviewed stroke rehabilitation guideline recommendations between January 1, 2010 and October 31, 2020. We explored electronic databases (N.=4), guideline repositories and professional rehabilitation networks (N.=12). Two independent reviewers used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, and brief syntheses were used to evaluate and compare the different recommendations, considering only the most recent version.EVIDENCE SYNTHESIS: From the 1219 papers screened, ten eligible guidelines were identified from seven different regions/countries. Four of the included guidelines focused on stroke management, the other six on stroke rehabilitation. Robotic rehabilitation is generally recommended to improve lower limb motor function, including gait and strength. Unfortunately, there is still no consensus about the timing, frequency, training session duration and the exact characteristics of subjects who could benefit from robotics.CONCLUSIONS: Our systematic review shows that the introduction of robotic rehabilitation in standard treatment protocols seems to be the future of stroke rehabilitation. However, robot assisted gait training (RAGT) for stroke needs to be improved with new solutions and in clinical practice guidelines, especially in terms of applicability

What does evidence tell us about the use of gait robotic devices in patients with multiple sclerosis? A comprehensive systematic review on functional outcomes and clinical recommendations

INTRODUCTION: There is growing evidence on the efficacy of gait robotic rehabilitation in patients with multiple sclerosis (MS), but most of the studies have focused on gait parameters. Moreover, clear indications on the clinical use of robotics still lack. As part of the CICERONE Italian Consensus on Robotic Rehabilitation, the aim of this systematic review was to investigate the existing evidence concerning the role of lower limb robotic rehabilitation in improving functional recovery in patients with MS. EVIDENCE ACQUISITION: We searched for and systematically reviewed evidence-based studies on gait robotic rehabilitation in MS, between January 1st, 2010 and December 31st, 2020, in the following databases: Cochrane Library, PEDro, PubMed and Google Scholar. The study quality was assessed by the 16-item assessment of multiple systematic reviews 2 (AMSTAR 2) and the 10-item PEDro scale for the other research studies. EVIDENCE SYNTHESIS: After an accurate screening, only 17 papers were included in the review, and most of them (13 RCT) had a level II evidence. Most of the studies used the Lokomat as a grounded robotic device, two investigated the efficacy of end-effectors and two powered exoskeletons. Generally speaking, robotic treatment has beneficial effects on gait speed, endurance and balance with comparable outcomes to those of conventional treatments. However, in more severe patients (EDSS >6), robotics leads to better functional outcomes. Notably, after gait training with robotics (especially when coupled to virtual reality) MS patients also reach better non-motor outcomes, including spasticity, fatigue, pain, psychological well-being and quality of life. Unfortunately, no clinical indications emerge on the treatment protocols. CONCLUSIONS: The present comprehensive systematic review highlights the potential beneficial role on functional outcomes of the lower limb robotic devices in people with MS. Future studies are warranted to evaluate the role of robotics not only for walking and balance outcomes, but also for other gait-training-related benefits, to identify appropriate outcome measures related to a specific subgroup of MS subjects' disease severity

A multi-center international study on the spinal cord independence measure, version IV: Rasch psychometric validation

The Spinal Cord Independence Measure is a comprehensive functional rating scale for individuals with spinal cord lesion (SCL). To validate the scores of the three subscales of SCIM IV, the fourth version of SCIM, using advanced statistical methods. Multi-center cohort study. Nineteen SCL units in 11 countries. SCIM developers created SCIM IV following comments by experts, included more accurate definitions of scoring criteria in the SCIM IV form, and adjusted it to assess specific conditions or situations that the third version, SCIM III, does not address. Professional staff members assessed 648 SCL inpatients, using SCIM IV and SCIM III, at admission to rehabilitation, and at discharge. The authors examined the validity and reliability of SCIM IV subscale scores using Rasch analysis. The study included inpatients aged 16–87 years old. SCIM IV subscale scores fit the Rasch model. All item infit and most item outfit mean-square indices were below 1.4; statistically distinct strata of abilities were 2.6–6; most categories were properly ordered; item hierarchy was stable across most clinical subgroups and countries. In a few items, however, we found misfit or category threshold disordering. We found SCIM III and SCIM IV Rasch properties to be comparable. Rasch analysis suggests that the scores of each SCIM IV subscale are reliable and valid. This reinforces the justification for using SCIM IV in clinical practice and research.</p