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. 2024;54(3):411-420.
doi: 10.3233/NRE-230367.

Implementation of a robot-mediated upper limb rehabilitation protocol for a customized treatment after stroke: A retrospective analysis

Arianna Pavan  1 , Alessio Fasano  1 , Laura Cortellini  1 , Stefania Lattanzi  1 , Dionysia Papadopoulou  1 , Sabina Insalaco  1 , Marco Germanotta  1 , Irene Aprile  1
Affiliations

Implementation of a robot-mediated upper limb rehabilitation protocol for a customized treatment after stroke: A retrospective analysis

Arianna Pavan et al. NeuroRehabilitation. 2024.

Abstract

Background: Many authors have emphasized the need for individualized treatments in rehabilitation, but no tailored robotic rehabilitation protocol for stroke patients has been established yet.

Objective: To evaluate the effectiveness of a robot-mediated upper limb rehabilitation protocol based on clinical assessment for customized treatment of stroke patients.

Methods: Clinical data from 81 patients with subacute stroke, undergoing an upper limb robot-mediated rehabilitation, were analyzed retrospectively. 49 patients were treated using a customized robotic protocol (experimental group, EG) based on a clinically guided flowchart, while 32 were treated without it (control group, CG). Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Motricity Index (MI), modified Barthel Index (mBI) and Numerical Rating Scale (NRS) measured before (T0) and after (T1) rehabilitation intervention were used as clinical outcomes.

Results: There was statistically significant improvement in both groups in terms of FMA-UE, MI, and mBI, while no change in NRS. Intergroup analysis showed significantly greater improvement of the FMA-UE (P = 0.002) and MI (P < 0.001) in the EG, compared with the CG.

Conclusion: The implementation of our robotic protocol for customized treatment of stroke patients yielded greater recovery in upper limb motor function and strength over robotic treatment without a defined protocol.

Keywords: Stroke; customized robotic treatment; rehabilitation; robotic treatment protocols; robotics; upper extremity.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Diagram of study design. Representation of the strategic phases of the work. In the initial phase, the first cohort of stroke patients underwent a 30-session robotic treatment without any defined, structured protocol. An intermediate phase consisted of protocol development based on an empirical method, starting from a daily evaluation of individual patients (within a new, intermediate group of patients) before and after treatment, and progressing to the construction of flowcharts with practical indications about parameter selection for each robot. Each intermediate evaluation helped to update therapists’ deductions regarding the optimal parameter selection. Treatment was tailored to the specific patient’s condition and was based on the evaluation of his/her ICF domains, namely range of motion, strength, spasticity, and pain. Finally, a new cohort of patients underwent a robotic treatment based on the implemented protocol. Data from the first (control) and the last (experimental) group of patients were included in our retrospective analysis. See the text for more details.
Fig. 2
Fig. 2
Mean values and standard deviations of the measures of the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), the Motricity Index (MI), the Numerical Rating Scale of Pain (NRS), and the modified Barthel Index (mBI) in the two groups (CG in red, EG in green). P values, referring to statistically significant values of the mean change from baseline (T1-T0) in each group, are reported in asterisks notation: *P < 0.05; **P < 0.01, ***P < 0.001.
Fig. 3
Fig. 3
Changes from baseline obtained in the Fugl-Meyer Assessment for Upper Extremity (ΔFMA-UE), in the Motricity Index (ΔMI), and in the modified Barthel Index (ΔmBI) in the two groups (CG in red, EG in green). P values, referring to statistically significant values of the intergroup differences of change from baseline, are reported in asterisks notation: *P < 0.05; **P < 0.01, ***P<0.001.
See this image and copyright information in PMC

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