Who may benefit from Armeo®Power treatment? A neurophysiological approach to predict neurorehabilitation outcomes.
ABSTRACT
Background:
The Armeo Power® is a rehabilitation exoskeleton that allows early treatment of motor disabilities providing intelligent arm support in a large 3D workspace to perform intensive, repetitive and goal oriented exercises. This device could efficiently induce new connections and plasticity phenomena potentiation. Therefore, the knowledge of the potential brain plasticity reservoir following brain damage constitutes a prerequisite for an optimal rehabilitation strategy.
Objective:
To identify potential neurophysiological markers predicting the responsiveness of stroke patients to upper limb robotic treatment.
Design:
Prospective, cohort study. Setting: Behavioral and Robotic Neurorehabilitation Laboratory of IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
PATIENTS:
We enrolled thirty-five stroke patients suffering with unilateral hemiplegia following a first-ever ischemic supra-tentorial stroke, at least 2 months before their enrolment. Methods or interventions: All patients underwent forty 1h Armeo Power® training sessions (i.e. five times a week for 8 weeks). Main outcome measurements: We assessed the spasticity and the motor function of upper limb by means of Modified Ashwort scale and Fugl-Meyer assessment, respectively. Moreover, we evaluated the cortical excitability and plasticity potential of the bilateral primary motor areas in response to repetitive paired associative stimulation paradigm using the transcranial magnetic stimulation, and Armeo Power® kinematic parameters.
Results:
The patients showing significant repetitive paired associative stimulation after-effects at baseline, exhibited an evident increase of cortical plasticity in the affected hemisphere (motor evoked potential amplitude increase p=.03), a decrease of inter-hemispheric inhibition (affected hemisphere cortical silent period duration decrease, p=.01; unaffected hemisphere cortical silent period duration increase, p=.004; repetitive paired associative stimulation aftereffect increase, p=.008). Such findings were paralleled by clinical (Fugl-Meyer, p=.04) and Armeo Power® kinematic (elbow flexion/extension, p=.02; shoulder range of movement p=.002) improvements.
Conclusions:
Our data suggest that the Armeo Power® practice may improve upper limb motor function recovery predicted by reshaping of cortical and trans-callosal plasticity, according to the baseline cortical excitability.
Автор: Rocco Salvatore Calabrò / Margherita Russo / Antonino Naro / Demetrio Milardi / Tina Balletta / Antonino Leo / Serena Filoni / Placido Bramanti
