Affiliations: [a] “Salvatore Maugeri” Foundation, IRCCS, Service of Bioengineering, Pavia, Italy | [b] “Salvatore Maugeri” Foundation, IRCCS, Service of Bioengineering, Veruno (NO), Italy | [c] “Salvatore Maugeri” Foundation, IRCCS, Division of Neurologic Rehabilitation, Veruno (NO), Italy
Correspondence:
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Address for correspondence: Ing. R. Colombo, Fondazione Salvatore Maugeri, Via Salvatore Maugeri 10, 27100 Pavia, Italy. Tel.: +39 0382 592207; Fax: +39 0382 592081; E-mail: roberto.colombo@fsm.it
Abstract: Background:Robotic neurorehabilitation, thanks to high dosage/intensity training protocols, has the potential for a greater impact on impairment. Objective:We aimed to analyze how time since the acute event may influence the motor recovery process during robot-assisted rehabilitation of the upper limb. Methods:A total of 41 patients after stroke were enrolled: 20 in subacute phase, i.e. ≤ 6 months elapsed since their unilateral cerebrovascular accident (CVA), and 21 at chronic stage, i.e. > 6 months since CVA. All subjects underwent 30 minutes of robot-aided rehabilitation twice a day, 5 days a week for at least three weeks of training. Patients were evaluated at the start and end of treatment using the Fugl-Meyer and Modified Ashworth clinical scales and by a set of robot measured kinematic parameters. The time interval from stroke was considered as a grouping factor to analyze its impact on time course of recovery. Results:After training both groups significantly improved their impairment (F = 44.25, p < 0.001) but sub-acute patients showed a greater improvement on the Fugl-Meyer scale than chronic patients. The time course of recovery of the kinematic variables showed higher time constants of motor improvement in the sub-acute than chronic group, but they were one order lower than spontaneous recovery time constants. Conclusions:Spontaneous recovery seems to have a limited impact on the improvement of sub-acute patients, most of their changes being likely due to re-learning during rehabilitation. In addition, a longer recovery time was required to maximize outcome in sub-acute than in chronic patients.
Keywords: Robotic therapy, motor recovery, stroke, spontaneous recovery, neurorehabilitation
