NeuroRehabilitation - Volume 51, issue 4

Authors: Morone, Giovanni | Riener, Robert | Mazzoleni, Stefano

Article Type: Editorial

DOI: 10.3233/NRE-228025

Citation: NeuroRehabilitation, vol. 51, no. 4, pp. 537-539, 2022

Authors: Bressi, Federica | Cricenti, Laura | Campagnola, Benedetta | Bravi, Marco | Miccinilli, Sandra | Santacaterina, Fabio | Sterzi, Silvia | Straudi, Sofia | Agostini, Michela | Paci, Matteo | Casanova, Emanuela | Marino, Dario | La Rosa, Giuseppe | Giansanti, Daniele | Perrero, Luca | Battistini, Alberto | Filoni, Serena | Sicari, Monica | Petrozzino, Salvatore | Solaro, Claudio Marcello | Gargano, Stefano | Benanti, Paolo | Boldrini, Paolo | Bonaiuti, Donatella | Castelli, Enrico | Draicchio, Francesco | Falabella, Vincenzo | Galeri, Silvia | Gimigliano, Francesca | Grigioni, Mauro | Mazzoleni, Stefano | Mazzon, Stefano | Molteni, Franco | Petrarca, Maurizio | Picelli, Alessandro | Posteraro, Federico | Senatore, Michele | Turchetti, Giuseppe | Morone, Giovanni | Gallotti, Marco | Germanotta, Marco | Aprile, Irene

Article Type: Review Article

Abstract: BACKGROUND: Robotic therapy (RT) has been internationally recognized for the motor rehabilitation of the upper limb. Although it seems that RT can stimulate and promote neuroplasticity, the effectiveness of robotics in restoring cognitive deficits has been considered only in a few recent studies. OBJECTIVE: To verify whether, in the current state of the literature, cognitive measures are used as inclusion or exclusion criteria and/or outcomes measures in robotic upper limb rehabilitation in stroke patients. METHODS: The systematic review was conducted according to PRISMA guidelines. Studies eligible were identified through PubMed/MEDLINE and Web of Science from inception …to March 2021. RESULTS: Eighty-one studies were considered in this systematic review. Seventy-three studies have at least a cognitive inclusion or exclusion criteria, while only seven studies assessed cognitive outcomes. CONCLUSION: Despite the high presence of cognitive instruments used for inclusion/exclusion criteria their heterogeneity did not allow the identification of a guideline for the evaluation of patients in different stroke stages. Therefore, although the heterogeneity and the low percentage of studies that included cognitive outcomes, seemed that the latter were positively influenced by RT in post-stroke rehabilitation. Future larger RCTs are needed to outline which cognitive scales are most suitable and their cut-off, as well as what cognitive outcome measures to use in the various stages of post-stroke rehabilitation. Show more

Keywords: Stroke, rehabilitation, cognitive outcome, robotic, upper limb, robotic rehabilitation, systematic review

DOI: 10.3233/NRE-220149

Citation: NeuroRehabilitation, vol. 51, no. 4, pp. 541-558, 2022

Authors: Straudi, Sofia | Baluardo, Ludovica | Arienti, Chiara | Bozzolan, Michela | Lazzarini, Stefano G. | Agostini, Michela | Aprile, Irene | Paci, Matteo | Casanova, Emanuela | Marino, Dario | La Rosa, Giuseppe | Bressi, Federica | Sterzi, Silvia | Giansanti, Daniele | Perrero, Luca | Battistini, Alberto | Miccinilli, Sandra | Filoni, Serena | Sicari, Monica | Petrozzino, Salvatore | Solaro, Claudio Marcello | Gargano, Stefano | Benanti, Paolo | Boldrini, Paolo | Bonaiuti, Donatella | Castelli, Enrico | Draicchio, Francesco | Falabella, Vincenzo | Galeri, Silvia | Gimigliano, Francesca | Grigioni, Mauro | Mazzoleni, Stefano | Mazzon, Stefano | Molteni, Franco | Petrarca, Maurizio | Picelli, Alessandro | Posteraro, Federico | Senatore, Michele | Turchetti, Giuseppe | Morone, Giovanni

Article Type: Review Article

Abstract: BACKGROUND: Robot-assisted arm therapy (RAT) has been used mainly in stroke rehabilitation in the last 20 years with rising expectations and growing evidence summarized in systematic reviews (SRs). OBJECTIVE: The aim of this study is to provide an overview of SRs about the effectiveness, within the ICF domains, and safety of RAT in the rehabilitation of adult with stroke compared to other treatments. METHODS: The search strategy was conducted using search strings adapted explicitly for each database. A screening base on title and abstract was realized to find all the potentially relevant studies. The methodological quality …of the included SRs was assessed using AMSTAR-2. A pre-determined standardized form was used to realize the data extraction. RESULTS: 18 SRs were included in this overview. Generally, positive effects from the RAT were found for motor function and muscle strength, whereas there is no agreement for muscle tone effects. No effect was found for pain, and only a SR reported the positive impact of RAT in daily living activity. CONCLUSION: RAT can be considered a valuable option to increase motor function and muscle strength after stroke. However, the poor quality of most of the included SRs could limit the certainty around the results. Show more

Keywords: Stroke, arm rehabilitation, robot-assisted arm therapy, end-effector devices, exoskeleton devices

DOI: 10.3233/NRE-220027

Citation: NeuroRehabilitation, vol. 51, no. 4, pp. 559-576, 2022

Authors: Grosmaire, Anne-Gaëlle | Pila, Ophélie | Breuckmann, Petra | Duret, Christophe

Article Type: Review Article

Abstract: BACKGROUND: Rehabilitation of stroke-related upper limb paresis is a major public health issue. OBJECTIVE: Robotic systems have been developed to facilitate neurorehabilitation by providing key elements required to stimulate brain plasticity and motor recovery, namely repetitive, intensive, adaptative training with feedback. Although the positive effect of robot-assisted therapy on motor impairments has been well demonstrated, the effect on functional capacity is less certain. METHOD: This narrative review outlines the principles of robot-assisted therapy for the rehabilitation of post-stroke upper limb paresis. RESULTS: A paradigm is proposed to promote not only recovery of impairment but …also function. CONCLUSION: Further studies that would integrate some principles of the paradigm described in this paper are needed. Show more

Keywords: Stroke, hemiparesis, rehabilitation, robot

DOI: 10.3233/NRE-220025

Citation: NeuroRehabilitation, vol. 51, no. 4, pp. 577-593, 2022

Authors: Mazzucchelli, Miryam | Mazzoleni, Daniele | Campanini, Isabella | Merlo, Andrea | Mazzoli, Davide | Melegari, Corrado | Colombo, Valentina | Cerulli, Simona | Piscitelli, Daniele | Perin, Cecilia | Andrenelli, Elisa | Bizzarini, Emiliana | Calabro, Rocco Salvatore | Carmignano, Simona Maria | Cassio, Anna | Chisari, Carmelo | Dalise, Stefania | Fundaro, Cira | Gazzotti, Valeria | 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 | Bonaiuti, Donatella

Article Type: Review Article

Abstract: 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. Show more

Keywords: Stroke, gait, rehabilitation, robotics, lower extremity

DOI: 10.3233/NRE-220024

Citation: NeuroRehabilitation, vol. 51, no. 4, pp. 595-608, 2022

Authors: Stampacchia, Giulia | Gazzotti, Valeria | Olivieri, Matteo | Andrenelli, Elisa | Bonaiuti, Donatella | Calabro, Rocco Salvatore | Carmignano, Simona Maria | Cassio, Anna | Fundaro, Cira | Companini, Isabella | Mazzoli, David | Cerulli, Simona | Chisari, Carmelo | Colombo, Valentina | Dalise, Stefania | Mazzoleni, Daniele | Melegari, Corrado | Merlo, Andrea | Boldrini, Paolo | Mazzoleni, Stefano | Posteraro, Federico | Mazzucchelli, Miriam | 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 | Bizzarrini, Emiliana

Article Type: Review Article

Abstract: BACKGROUND: Many robots are available for gait rehabilitation (BWSTRT and ORET) and their application in persons with SCI allowed an improvement of walking function. OBJECTIVE: The aim of the study is to compare the effects of different robotic exoskeletons gait training in persons with different SCI level and severity. METHODS: Sixty-two studies were included in this systematic review; the study quality was assessed according to GRADE and PEDro’s scale. RESULTS: Quality assessment of included studies (n  = 62) demonstrated a prevalence of evidence level 2; the quality of the studies was higher for BWSTRT (excellent …and good) than for ORET (fair and good). Almost all persons recruited for BWSTRT had an incomplete SCI; both complete and incomplete SCI were recruited for ORET. The SCI lesion level in the persons recruited for BWSTRT are from cervical to sacral; mainly from thoracic to sacral for ORET; a high representation of AIS D lesion resulted both for BWSTRT (30%) and for ORET (45%). The walking performance, tested with 10MWT, 6MWT, TUG and WISCI, improved after exoskeleton training in persons with incomplete SCI lesions, when at least 20 sessions were applied. Persons with complete SCI lesions improved the dexterity in walking with exoskeleton, but did not recover independent walking function; symptoms such as spasticity, pain and cardiovascular endurance improved. CONCLUSION: Different exoskeletons are available for walking rehabilitation in persons with SCI. The choice about the kind of robotic gait training should be addressed on the basis of the lesion severity and the possible comorbidities. Show more

Keywords: Gait rehabilitation, exoskeleton robot, spinal cord injury

DOI: 10.3233/NRE-220061

Citation: NeuroRehabilitation, vol. 51, no. 4, pp. 609-647, 2022

Authors: Carmignano, Simona Maria | Fundarò, Cira | Bonaiuti, Donatella | Calabrò, 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, Elisa

Article Type: Review Article

Abstract: BACKGROUND: 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. Show more

Keywords: Parkinson’s disease, rehabilitation, gait, medical device

DOI: 10.3233/NRE-220026

Citation: NeuroRehabilitation, vol. 51, no. 4, pp. 649-663, 2022

Authors: Castelli, Enrico | Beretta, Elena | De Tanti, Antonio | Arduini, Francesca | Biffi, Emilia | Colazza, Alessandra | Di Pede, Chiara | Guzzetta, Andrea | Lucarini, Ludovica | Maghini, Irene | Mandalà, Martina | Nespoli, Maurizio | Pavarelli, Claudia | Policastro, Francesca | Polverelli, Marco | Rossi, Andrea | Sgandurra, Giuseppina | Boldrini, Paolo | Bonaiuti, Donatella | Mazzoleni, Stefano | Posteraro, Federico | Benanti, Paolo | Draicchio, Francesco | Falabella, Vincenzo | Galeri, Silvia | Gimigliano, Francesca | Grigioni, Mauro | Mazzon, Stefano | Molteni, Franco | Morone, Giovanni | Petrarca, Maurizio | Picelli, Alessandro | Senatore, Michele | Turchetti, Giuseppe | Saviola, Donatella

Article Type: Review Article

Abstract: BACKGROUND: The use of robotic technologies in pediatric rehabilitation has seen a large increase, but with a lack of a comprehensive framework about their effectiveness. OBJECTIVE: An Italian Consensus Conference has been promoted to develop recommendations on these technologies: definitions and classification criteria of devices, indications and limits of their use in neurological diseases, theoretical models, ethical and legal implications. In this paper, we present the results for the pediatric age. METHODS: A systematic search on Cochrane Library, PEDro and PubMed was performed. Papers published up to March 1st, 2020, in English, were included and analyzed …using the methodology of the Centre for Evidence-Based Medicine in Oxford, AMSTAR2 and PEDro scales for systematic reviews and RCT, respectively. RESULTS: Some positives aspects emerged in the area of gait: an increased number of children reaching the stance, an improvement in walking distance, speed and endurance. Critical aspects include the heterogeneity of the studied cases, measurements and training protocols. CONCLUSION: Many studies demonstrate the benefits of robotic training in developmental age. However, it is necessary to increase the number of trials to achieve greater homogeneity between protocols and to confirm the effectiveness of pediatric robotic rehabilitation. Show more

Keywords: Robots, rehabilitation, gait, upper limb, lower limb, children

DOI: 10.3233/NRE-220036

Citation: NeuroRehabilitation, vol. 51, no. 4, pp. 665-679, 2022

Authors: Turolla, Andrea | Kiper, Pawel | Mazzarotto, Deborah | Cecchi, Francesca | Colucci, Mariele | D’Avenio, Giuseppe | Facciorusso, Salvatore | Gatti, Roberto | Giansanti, Daniele | Iosa, Marco | Bonaiuti, Donatella | Boldrini, Paolo | Mazzoleni, Stefano | Posteraro, Federico | Benanti, Paolo | Castelli, Enrico | Draicchio, Francesco | Falabella, Vincenzo | Galeri, Silvia | Gimigliano, Francesca | Grigioni, Mauro | Mazzon, Stefano | Morone, Giovanni | Petrarca, Maurizio | Picelli, Alessandro | Senatore, Michele | Turchetti, Giuseppe | Molteni, Franco

Article Type: Review Article

Abstract: BACKGROUND: Robot-based treatments are developing in neurorehabilitation settings. Recently, the Italian National Health Systems recognized robot-based rehabilitation as a refundable service. Thus, the Italian neurorehabilitation community promoted a national consensus on this topic. OBJECTIVE: To conceptualize undisclosed perspectives for research and applications of robotics for neurorehabilitation, based on a qualitative synthesis of reference theoretical models. METHODS: A scoping review was carried out based on a specific question from the consensus Jury. A foreground search strategy was developed on theoretical models (context) of robot-based rehabilitation (exposure), in neurological patients (population). PubMed and EMBASE® databases were searched …and studies on theoretical models of motor control, neurobiology of recovery, human-robot interaction and economic sustainability were included, while experimental studies not aimed to investigate theoretical frameworks, or considering prosthetics, were excluded. RESULTS: Overall, 3699 records were screened and finally 9 papers included according to inclusion and exclusion criteria. According to the population investigated, structured information on theoretical models and indications for future research was summarized in a synoptic table. CONCLUSION: The main indication from the Italian consensus on robotics in neurorehabilitation is the priority to design research studies aimed to investigate the role of robotic and electromechanical devices in promoting neuroplasticity. Show more

Keywords: Robot-assisted rehabilitation, theoretical models, neurorehabilitation, Consensus Conference

DOI: 10.3233/NRE-220160

Citation: NeuroRehabilitation, vol. 51, no. 4, pp. 681-691, 2022

Authors: Liguori, Sara

Article Type: Other

Abstract: BACKGROUND: Neuromuscular diseases (NMDs) are conditions characterized by progressive muscle weakness resulting in limitations in the activities of daily living. Physical inactivity in this population represents a major health issue increasing the risk of further chronic health problems and complications. OBJECTIVE: To discuss evidence on the effects of intervention for promoting physical activity in people with NMDs from a rehabilitative perspective. METHODS: To summarize and comment on the published Cochrane Review “Interventions for promoting physical activity in people with neuromuscular disease” by Jones et al. RESULTS: This Cochrane Review included 13 trials (795 participants from …12 studies, number of participants unclear in one study) evaluating practical, informational, or motivational interventions, designed to promote physical activity, in comparison to no intervention, or another intervention. CONCLUSION: A low- to very-low certainty of the evidence was found on the effectiveness of physical activity-promoting interventions in people with NMD. Further studies are required to address this topic. Show more

Keywords: Physical activity, neuromuscular disease, exercise, muscle, lifestyle

DOI: 10.3233/NRE-228026

Citation: NeuroRehabilitation, vol. 51, no. 4, pp. 693-695, 2022