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Journal of NeuroEngineering and Rehabilitation
Published in: Journal of NeuroEngineering and Rehabilitation 1/2018

Open Access 01-12-2018 | Research

Using an upper extremity exoskeleton for semi-autonomous exercise during inpatient neurological rehabilitation- a pilot study

Authors: Imke Büsching, Aida Sehle, Jana Stürner, Joachim Liepert

Published in: Journal of NeuroEngineering and Rehabilitation | Issue 1/2018

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Abstract

Background

Motor deficits are the most common symptoms after stroke. There is some evidence that intensity and amount of exercises influence the degree of improvement of functions within the first 6 months after the injury.
The purpose of this pilot study was to evaluate the feasibility and acceptance of semi-autonomous exercises with an upper extremity exoskeleton in addition to an inpatient rehabilitation program. In addition, changes of motor functions were examined.

Methods

Ten stroke patients with a severe upper extremity paresis were included. They were offered to perform a semi-autonomous training with a gravity-supported, computer-enhanced device (Armeo®Spring, Hocoma AG) six times per week for 4 weeks. Feasibility was evaluated by weekly structured interviews with patients and supervisors.
Motor functions were assessed before and after the training period using the Wolf Motor Function Test (WMFT). The Wilcoxon Signed Rank Test was used for assessing pre-post differences. The Pearson correlation co-efficient was used for correlating the number of completed sessions with the change in motor function. Acceptance of the device and the level of satisfaction with the training were determined by a questionnaire based on visual analogue scales.

Results

Neither patients nor supervisors reported side effects. However, one patient had to be excluded from analysis because of transportation difficulties from the ward to the treatment facility. Therefore, analysis was based on nine patients. On average, 13.2 (55%) sessions were realized. WMFT results showed significant improvements of proximal arm functions. The number of sessions correlated with the degree of shoulder force improvement. Patients rated the exercises to be motivating, and enjoyable and would continue using the Armeo®Spring at home if they had the opportunity.

Conclusion

Using an upper extremity exoskeleton for semi-autonomous training in an inpatient setting is feasible without side effects and is positively rated by the patients. It might further support the recovery of upper extremity function.

Trial registration

The trial was retrospectively registered. Registration number ISRCTN42633681.
Literature
1.
Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, Moran AE, Sacco RL, Anderson L, Truelsen T, O'Donnell M, Venketasubramanian N, Barker-Collo S, Lawes CM, Wang W, Shinohara Y, Witt E, Ezzati M, Naghavi M, Murray C. Global burden of diseases, injuries, and risk factors study 2010 (GBD 2010) and the GBD stroke experts group. Global and regional burden of stroke during 1990-2010: findings from the global burden of disease study 2010. Lancet. 2014;383(9913):245–54.CrossRefPubMedPubMedCentral
2.
Busch MA, Schienkiewitz A, Nowossadeck E, Gößwald A. Prävalenz des Schlaganfalls bei Erwachsenen im Alter von 40 bis 79 Jahren in Deutschland. Bundesgesundheitsbl. 2013;56:656–60.CrossRef
3.
Rathore SS, Hinn AR, Cooper LS, Tyroler HA, Rosamond WD. Characterization of incident stroke signs and symptoms: findings from the atherosclerosis risk in communities study. Stroke. 2002;33(11):2718–21.CrossRefPubMed
4.
Winstein CJ, Wolf SL, Dromerick AW, Lane CJ, Nelsen MA, Lewthwaite R, Blanton S, Scott C, Reiss A, Cen SY, Holley R, Azen SP. ICARE investigative team. Interdisciplinary comprehensive arm rehabilitation evaluation (ICARE): a randomized controlled trial protocol. BMC Neurol. 2013;13(5)
5.
Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, van Wijck F. Interventions for improving upper limb function after stroke. Cochrane Database Syst Rev 2014;(11):CD010820.
6.
Mehrholz J, Pohl M, Platz T, Kugler J, Elsner B. Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst Rev. 2015;11:CD006876.
7.
Han C, Wang Q, Meng PP, Qi MZ. Effects of intensity of arm training on hemiplegic upper extremity motor recovery in stroke patients: a randomized controlled trial. Clin Rehabil. 2013;27(1):75–81.CrossRefPubMed
8.
Lang CE, Lohse KR, Birkenmeier RL. Dose and timing in neurorehabilitation: prescribing motor therapy after stroke. Curr Opin Neurol. 2015;28(6):549–55.CrossRefPubMedPubMedCentral
9.
Krakauer JW, Carmichael ST, Corbett D, Wittenberg GF. Getting neurorehabilitation right: what can be learned from animal models? Neurorehabil Neural Repair. 2012;26(8):923–31.CrossRefPubMedPubMedCentral
10.
Meimoun M, Bayle N, Baude M, Gracies JM. Intensity in the neurorehabilitation of spastic paresis. Rev Neurol (Paris). 2015;171(2):130–40.CrossRef
11.
12.
Housman SJ, Scott KM, Reinkensmeyer DJ. A randomized controlled trial of gravity-supported, computer-enhanced arm exercise for individuals with severe hemiparesis. Neurorehabil Neural Repair. 2009;23(5):505–14.CrossRefPubMed
13.
Chan IH, Fong KN, Chan DY, Wang AQ, Cheng EK, Chau PH, Chow KK, Cheung HK. Effects of arm weight support training to promote recovery of upper limb function for subacute patients after stroke with different levels of arm impairments. Biomed Res Int. 2016;2016:9346374.PubMedPubMedCentral
14.
Colomer C, Baldoví A, Torromé S, Navarro MD, Moliner B, Ferri J, Noé E. Efficacy of Armeo® spring during the chronic phase of stroke. Study in mild to moderate cases of hemiparesis. Neurologia. 2013;28(5):261–7.CrossRefPubMed
15.
Bartolo M, De Nunzio AM, Sebastiano F, Spicciato F, Tortola P, Nilsson J, Pierelli F. Arm weight support training improves functional motor outcome and movement smoothness after stroke. Funct Neurol. 2014;29(1):15–21.PubMedPubMedCentral
16.
Taveggia G, Borboni A, Salvi L, Mulé C, Fogliaresi S, Villafañe JH, Casale R. Efficacy of robot-assisted rehabilitation for the functional recovery of the upper limb in post-stroke patients: a randomized controlled study. Eur J Phys Rehabil Med. 2016;52(6):767–73.PubMed
17.
Grimm F, Naros G, Gharabaghi A. Closed-loop task difficulty adaptation during virtual reality reach-to-grasp training assisted with an exoskeleton for stroke rehabilitation. Front Neurosci. 2016;10:518.PubMedPubMedCentral
18.
Wolf SL, Catlin PA, Ellis M, Archer AL, Morgan B, Piacentino A. Assessing wolf motor function test as outcome measure for research in patients after stroke. Stroke. 2001;32(7):1635–9.CrossRefPubMed
19.
McCormack HM, Horne DJ, Sheather S. Clinical applications of visual analogue scales: a critical review. Psychol Med. 1988;18(4):1007–19.CrossRefPubMed
20.
Zimmerli L, Krewer C, Gassert R, Müller F, Riener R, Lünenburger L. Validation of a mechanism to balance exercise difficulty in robot-assisted upper-extremity rehabilitation after stroke. J Neuroeng Rehabil. 2012;9:6.CrossRefPubMedPubMedCentral
21.
Nienhuis SM, Prange GB, Amirabdollahian F, Sale P, Infarinato F, Nasr N, Mountain G, Hermens HJ, Stienen AH, Buurke JH, Rietman JS. Feasibility study into self-administered training at home using an arm and hand device with motivational gaming environment in chronic stroke. J Neuroeng Rehabil. 2015;12:89.CrossRef
22.
Sivan M, Gallagher J, Makower S, Keeling D, Bhakta B, O’Connor RJ, Levesley M. Home-based computer assisted arm rehabilitation (hCAAR) robotic device for upper limb exercise after stroke: results of a feasibility study in home setting. J Neuroeng Rehabil. 2014;11:163.CrossRefPubMedPubMedCentral
23.
24.
Wittmann F, Held JP, Lambercy O, Starkey ML, Curt A, Höver R, Gassert R, Luft AR, Gonzenbach RR. Self-directed arm therapy at home after stroke with a sensor-based virtual reality training system. J Neuroeng Rehabil. 2016;13(1):75.CrossRefPubMedPubMedCentral
25.
Zondervan DK, Augsburger R, Bodenhoefer B, Friedman N, Reinkensmeyer DJ, Cramer SC. Machine-based, self-guided home therapy for individuals with severe arm impairment after stroke: a randomized controlled trial. Neurorehabil Neural Repair. 2015;29(5):395–406.CrossRefPubMed
26.
Brokaw EB, Nichols D, Holley RJ, Lum PS. Robotic therapy provides a stimulus for upper limb motor recovery after stroke that is complementary to and distinct from conventional therapy. Neurorehabil Neural Repair. 2014;28(4):367–76.CrossRefPubMed
27.
Prange GB, Kottink AI, Buurke JH, Eckhardt MM, Van Keulen-Rouweler BJ, Ribbers GM, Rietman JS. The effect of arm support combined with rehabilitation games on upper-extremity function in subacute stroke: a randomized controlled trial. Neurorehabil Neural Repair. 2015;29(2):174–82.CrossRefPubMed
Metadata
Title
Using an upper extremity exoskeleton for semi-autonomous exercise during inpatient neurological rehabilitation- a pilot study
Authors
Imke Büsching
Aida Sehle
Jana Stürner
Joachim Liepert
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Journal of NeuroEngineering and Rehabilitation / Issue 1/2018
Electronic ISSN: 1743-0003
DOI
https://doi.org/10.1186/s12984-018-0415-6

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