Robotic Kinematic measures of the arm in chronic Stroke: part 1 – Motor Recovery patterns from tDCS preceding intensive training
Name
42234_2021_Article_81.pdf
Size
1.66 MB
Format
Adobe PDF
Checksum (MD5)
fd0f590e44980a3320966654a46c9788
Author(s)
Moretti, Caio B.
Edwards, Dylan J.
Hamilton, Taya
Cortes, Mar
Peltz, Avrielle R.
Chang, Johanna L.
Delbem, Alexandre C. B.
Volpe, Bruce T.
Krebs, Hermano I.
Date Issued
December 29, 2021
Publisher
BioMed Central
Citation
Bioelectronic Medicine. 2021 Dec 29;7(1):20
Version
Final published version
Abstract
Abstract
Background
Effectiveness of robotic therapy and transcranial direct current stimulation is conventionally assessed with clinical measures. Robotic metrics may be more objective and sensitive for measuring the efficacy of interventions on stroke survivor’s motor recovery. This study investigated if robotic metrics detect a difference in outcomes, not seen in clinical measures, in a study of transcranial direct current stimulation (tDCS) preceding robotic therapy. Impact of impairment severity on intervention response was also analyzed to explore optimization of outcomes by targeting patient sub-groups.
Methods
This 2020 study analyzed data from a double-blind, sham-controlled, randomized multi-center trial conducted from 2012 to 2016, including a six-month follow-up. 82 volunteers with single chronic ischemic stroke and right hemiparesis received anodal tDCS or sham stimulation, prior to robotic therapy. Robotic therapy involved 1024 repetitions, alternating shoulder-elbow and wrist robots, for a total of 36 sessions. Shoulder-elbow and wrist kinematic and kinetic metrics were collected at admission, discharge, and follow-up.
Results
No difference was detected between the tDCS or sham stimulation groups in the analysis of robotic shoulder-elbow or wrist metrics. Significant improvements in all metrics were found for the combined group analysis. Novel wrist data showed smoothness significantly improved (P < ·001) while submovement number trended down, overlap increased, and interpeak interval decreased. Post-hoc analysis showed only patients with severe impairment demonstrated a significant difference in kinematics, greater for patients receiving sham stimulation.
Conclusions
Robotic data confirmed results of clinical measures, showing intensive robotic therapy is beneficial, but no additional gain from tDCS. Patients with severe impairment did not benefit from the combined intervention. Wrist submovement characteristics showed a delayed pattern of motor recovery compared to the shoulder-elbow, relevant to intensive intervention-related recovery of upper extremity function in chronic stroke.
Trial registration
http://www.clinicaltrials.gov
. Actual study start date September 2012. First registered on 15 November 2012. Retrospectively registered. Unique identifiers:
NCT01726673
and
NCT03562663
.
MIT Department
Massachusetts Institute of Technology. Department of Mechanical Engineering
Terms of Use
Creative Commons Attribution
Persistent DSpace Link
DOI of Published Version
https://doi.org/10.1186/s42234-021-00081-9
