Molteni Franco, Gasperini Giulio, Cannaviello Giovanni, Guanziroli Eleonora
Valduce Hospital "Villa Beretta" Rehabilitation Center, Costa Masnaga, Italy(∗).
Valduce Hospital "Villa Beretta" Rehabilitation Center, Costa Masnaga, Italy(†).
PM R. 2018 Sep;10(9 Suppl 2):S174-S188. doi: 10.1016/j.pmrj.2018.06.005.
Recovery of upper and lower limbs function is essential to reach independence in daily activities in patients with upper motor neuron syndrome (UMNS). Rehabilitation can provide a guide for motor recovery influencing the neurobiology of neuronal plasticity providing controlled, repetitive, and variable patterns. Increasing therapy dosage, intensity, number of repetition, execution of task-oriented exercises, and combining top-down and bottom-up approaches can promote plasticity and functional recovery. Robotic exoskeletons for upper and lower limbs, based on the principle of motor learning, have been introduced in neurorehabilitation. In this narrative review, we provide an overview of literature published on exoskeleton devices for upper and lower limb rehabilitation in patients with UMNS; we summarized the available current research evidence and outlined the new challenges that neurorehabilitation and bioengineering will have to face in the upcoming years. Robotic treatment should be considered a rehabilitation tool useful to generate a more complex, controlled multisensory stimulation of the patient and useful to modify the plasticity of neural connections through the experience of movement. Efficacy and efficiency of robotic treatment should be defined starting from intensity, complexity, and specificity of the robotic exercise, that are related to human-robot interaction in terms of motion, emotion, motivation, meaning of the task, feedback from the exoskeleton, and fine motion assistance. Duration of a single session, global period of the treatment, and the timing for beginning of robotic treatment are still open questions. There is the need to evaluate and individualize the treatment according to patient's characteristics. Robotic devices for upper and lower limbs open a window to define therapeutic modalities as possible beneficial drug, able to boost biological, neurobiological, and epigenetic changes in central nervous system. We need to implement large and innovative research programs to answer these issues in the near future.
对于上运动神经元综合征（UMNS）患者而言，恢复上下肢功能对于实现日常活动的自理至关重要。康复治疗可为运动恢复提供指导，影响神经元可塑性的神经生物学，提供可控、重复且多变的模式。增加治疗剂量、强度、重复次数、执行任务导向性练习以及结合自上而下和自下而上的方法可促进可塑性和功能恢复。基于运动学习原理的上下肢机器人外骨骼已被引入神经康复领域。在这篇叙述性综述中，我们概述了已发表的关于UMNS患者上下肢康复外骨骼装置的文献；总结了现有的研究证据，并概述了神经康复和生物工程在未来几年将面临的新挑战。机器人治疗应被视为一种康复工具，有助于对患者产生更复杂、可控的多感官刺激，并通过运动体验来改变神经连接的可塑性。机器人治疗的疗效和效率应从机器人运动的强度、复杂性和特异性来界定，这些与运动、情感、动机、任务意义、外骨骼反馈以及精细运动辅助方面的人机交互有关。单次治疗的时长、整个治疗周期以及开始机器人治疗的时机仍是悬而未决的问题。有必要根据患者的特征评估并个性化治疗方案。上下肢机器人装置为定义治疗方式打开了一扇窗，这些方式可能如同有益药物一般，能够促进中枢神经系统的生物学、神经生物学和表观遗传学变化。我们需要在不久的将来实施大型创新性研究项目来回答这些问题。
