Effects of Assist-As-Needed Upper Extremity Robotic Therapy after Incomplete Spinal Cord Injury: A Parallel-Group Controlled Trial
Effects of Assist-As-Needed Upper Extremity Robotic Therapy after Incomplete Spinal Cord Injury: A Parallel-Group Controlled Trial
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DOI：
10.3389/fnbot.2017.00026
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发表时间：
2017-06-13
影响因子：
3.1
通讯作者：
O'Malley, Marcia K.
中科院分区：
文献类型：
--
作者：
Frullo, John Michael;Elinger, Jared;O'Malley, Marcia K.
背景资料：神经损伤后上肢的机器人康复已经通过几项针对慢性中风患者的大型临床研究得到了支持。尽管有迹象表明，中风后运动能力恢复的成功策略也可能使不完全脊髓损伤（SCI）患者受益，但机器人康复在其他神经损伤治疗中的应用还不太发达。虽然最近的研究表明，机器人辅助康复可能是有益的后不完全SCI，目前还不清楚什么类型的机器人辅助干预有助于运动恢复。方法：我们开发了一种新型的按需辅助（AAN）机器人控制器，用于在通过上肢外骨骼（MAHI Exo-II）提供的康复治疗期间连续调整挑战和机器人辅助，训练独立的肘关节和腕关节运动。我们还在平行组平衡对照试验中招募了17名不完全脊髓损伤（AIS C级和D级）患者，以测试AAN控制器与受试者触发（ST）控制器的疗效，ST控制器在治疗期间不连续调整辅助或激发水平。进行的研究是第二阶段，概念的发展试点study.Results：我们验证了AAN控制器在其能力的调制援助和挑战，通过纵向机器人指标分析治疗过程中。对于选定的主要结局指标，ARAT评分的前后差异，在两组受试者中均未测量到统计学显著变化。通过机器人测试获得的次要结局指标的辅助分析表明，两组在治疗程序期间的运动质量逐渐改善，AAN控制器的运动质量比ST控制器有更大的提高。本研究证明了不完全脊髓损伤后受试者自适应机器人治疗的可行性，但是没有证明由于机器人辅助康复程序而发生的手臂功能的增益，也没有证明由于所开发的AAN控制器而获得的微分增益。进一步的研究是必要的，以更好地量化的恢复潜力提供的AAN控制策略的机器人上肢康复不完全SCI。
Background: Robotic rehabilitation of the upper limb following neurological injury has been supported through several large clinical studies for individuals with chronic stroke. The application of robotic rehabilitation to the treatment of other neurological injuries is less developed, despite indications that strategies successful for restoration of motor capability following stroke may benefit individuals with incomplete spinal cord injury (SCI) as well. Although recent studies suggest that robot-aided rehabilitation might be beneficial after incomplete SCI, it is still unclear what type of robot-aided intervention contributes to motor recovery.Methods: We developed a novel assist-as-needed (AAN) robotic controller to adjust challenge and robotic assistance continuously during rehabilitation therapy delivered via an upper extremity exoskeleton, the MAHI Exo-II, to train independent elbow and wrist joint movements. We further enrolled seventeen patients with incomplete spinal cord injury (AIS C and D levels) in a parallel-group balanced controlled trial to test the efficacy of the AAN controller, compared to a subject-triggered (ST) controller that does not adjust assistance or challenge levels continuously during therapy. The conducted study is a stage two, development-of-concept pilot study.Results: We validated the AAN controller in its capability of modulating assistance and challenge during therapy via analysis of longitudinal robotic metrics. For the selected primary outcome measure, the pre-post difference in ARAT score, no statistically significant change was measured in either group of subjects. Ancillary analysis of secondary outcome measures obtained via robotic testing indicates gradual improvement in movement quality during the therapy program in both groups, with the AAN controller affording greater increases in movement quality over the ST controller.Conclusion: The present study demonstrates feasibility of subject-adaptive robotic therapy after incomplete spinal cord injury, but does not demonstrate gains in arm function occurring as a result of the robot-assisted rehabilitation program, nor differential gains obtained as a result of the developed AAN controller. Further research is warranted to better quantify the recovery potential provided by AAN control strategies for robotic rehabilitation of the upper limb following incomplete SCI.