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Observational Study
. 2021 Dec;42(12):5219-5229.
doi: 10.1007/s10072-021-05185-3. Epub 2021 Apr 7.

Robotic rehabilitation for end-effector device and botulinum toxin in upper limb rehabilitation in chronic post-stroke patients: an integrated rehabilitative approach

Teresa Paolucci  1 , Francesco Agostini  2 , Massimiliano Mangone  3 , Andrea Bernetti  2 , Letizia Pezzi  1 , Vitalma Liotti  4 , Elena Recubini  4 , Cristina Cantarella  4 , Rosa Grazia Bellomo  5 , Carlo D'Aurizio  4 , Raoul Saggini  1   6
Affiliations
Observational Study

Robotic rehabilitation for end-effector device and botulinum toxin in upper limb rehabilitation in chronic post-stroke patients: an integrated rehabilitative approach

Teresa Paolucci et al. Neurol Sci. 2021 Dec.

Abstract

Background: Determine the effects of an integrated rehabilitation protocol, including botulinum toxin and conventional rehabilitation exercise plus end-effector (EE) robotic training for functional recovery of the upper limb (UL) compared to training with the robot alone in post-chronic stroke patients with mild to severe spasticity, compared to training with the robot alone.

Methods: In this prospective, observational case-control study, stroke patients were allocated into 2 groups: robot group (RG, patients who underwent robotic treatment with EE) and robot-toxin group (RTG, patients who in addition have carried out the injection of botulinum toxin for UL recovery). All patients were assessed by Fugl-Meyer Assessment (FMA), Motricity Index (MI), modified Ashworth scale (MAS), numeric rating scale (NRS), Box and Block Test (BBT), Frenchay Arm Test (FAT), and Barthel Index (BI) at baseline (T0), T1 (end of treatment), and T2 (3 months of follow-up).

Results: Forty-four patients were included and analyzed (21RG; 23RTG). From the analysis between groups, the results suggested how there was a statistically significant difference in favor of RTG, specifically ΔT0-T1 and ΔT0-T2 for B&B p = 0.009 and p = 0.035; ΔT0-T1 and ΔT0-T2 for FAT with p = 0.016 and p = 0.031; ΔT0-T1 for MAS shoulder p = 0.016; ΔT0-T1 and ΔT0-T2 with p = 0.010 and p = 0.005 for MAS elbow; and ΔT0-T1 and ΔT0-T2 with p = 0.001 and p = 0.013 for MAS wrist.

Conclusion: Our results suggest, in line with the literature, a good efficacy in the reduction of spasticity and in the improvement of the function of the UL, with the reduction of pain, adopting a rehabilitation protocol integrated with BoTN, robot-assisted training, and traditional physiotherapy.

Keywords: Evaluation model; Motion control skill; Robotic end-effector kinematic feature; Surgical robot system.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
MObile roboT for upper limb neuroOrtho Rehabilitation (MOTORE)
Fig. 2
Fig. 2
Robot end-effector protocol. a Trajectories; b pursuit; c coins; d memory; e washing dishes; f moles; g archery
Fig. 3
Fig. 3
Flowchart
See this image and copyright information in PMC

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