Physical Medicine and Rehabilitation Department, Campus Bio-Medico University of Rome, Italy.
J Biol Regul Homeost Agents. 2020 Sep-Oct;34(5 Suppl. 3):11-44. Technology in Medicine.
Stroke is the second cause of mortality and the third cause of long-term disability worldwide. Deficits in upper limb (UL) capacity persist at 6 months post-stroke in 30-66% of hemiplegic stroke patients with major limitations in activity of daily living (ADL), thus making the recovery of paretic UL function the main rehabilitation goal. Robotic rehabilitation plays a crucial role since it allows to perform a repetitive, intensive, and task-oriented treatment, adaptable to the patients' residual abilities, necessary to facilitate recovery and the rehabilitation of the paretic UL. It has been proposed that robot-mediated training may amplify neuroplasticity by providing a major interaction of proprioceptive and/or other sensory inputs with motor outputs, with significant modifications in functional connectivity (coherence) within the fronto-parietal networks (inter- and intra-hemispheric functional connectivity) related to processes of movement preparation and execution. However, the neurophysiological mechanisms underlying this reorganization are not entirely clear yet. Therefore, the aim of this study is to revise the literature, which assesses the effect of robotic treatment in the recovery of UL deficits measured in terms of neuroplasticity in patients affected by chronic stroke. This systematic review was conducted using PubMed, PEDro, Cinahl (EBSCOhost), Scopus and Cochrane databases. The research was carried out until February 2020 it included articles written in English language, published between 2009 and 2020, and the outcomes considered were neuroplasticity assessments. We included 23 studies over 6145 records identified from the preliminary research. The selected studies proposed different methods for neuroplasticity assessment (i.e. transcranial direct current stimulation (tDCS), EEG-Based Brain Computer Interface (BCI) and Neuroimaging (fMRI)), and different Robotic Rehabilitation treatments. These studies demonstrated a positive correlation between changes in central nervous circuits and post-treatment clinical outcomes. Our study has highlighted the effectiveness of robotic therapy in promoting mechanisms that facilitate re-learning and motor recovery in patients with post-stroke chronic disabilities. However, future studies should overcome the limitations of heterogeneity found in the current literature, by proposing a greater number of high-level RCTs, to better understand the mechanisms of robot-induced neuroplasticity, follow the clinical progress, estimate a prognosis of recovery of motor function, and plan a personalized rehabilitative programme for the patients.
中风是全球范围内第二大致死原因和第三大致长期残疾原因。在 30-66%的偏瘫中风患者中,上肢(UL)能力缺陷在中风后 6 个月仍然存在,日常生活活动(ADL)严重受限,因此,恢复瘫痪的 UL 功能成为主要的康复目标。机器人康复起着至关重要的作用,因为它可以进行重复、密集、以任务为导向的治疗,适应患者的残留能力,这对于促进恢复和瘫痪 UL 的康复是必要的。已经提出,机器人介导的训练可以通过提供本体感觉和/或其他感觉输入与运动输出的主要相互作用,以及与运动准备和执行相关的额顶网络(半球间和半球内功能连接)内的功能连接(相干性)的显著改变,来放大神经可塑性。然而,这种重组的神经生理机制尚不完全清楚。因此,本研究旨在综述文献,评估机器人治疗对慢性中风患者 UL 缺陷恢复的影响,从神经可塑性的角度进行评估。这项系统综述使用了 PubMed、PEDro、CINHAL(EBSCOhost)、Scopus 和 Cochrane 数据库进行。研究于 2020 年 2 月前进行,包括了用英语撰写、发表于 2009 年至 2020 年期间的文章,考虑的结果是神经可塑性评估。我们从初步研究中筛选出了 23 篇研究,共涉及 6145 条记录。选定的研究提出了不同的神经可塑性评估方法(即经颅直流电刺激(tDCS)、基于脑电图的脑机接口(BCI)和神经影像学(fMRI))和不同的机器人康复治疗方法。这些研究表明,中枢神经回路的变化与治疗后的临床结果之间存在正相关。我们的研究强调了机器人治疗在促进中风后慢性残疾患者重新学习和运动恢复机制方面的有效性。然而,未来的研究应该克服当前文献中发现的异质性限制,提出更多的高水平 RCT,以更好地理解机器人诱导的神经可塑性的机制,跟踪临床进展,估计运动功能恢复的预后,并为患者制定个性化的康复计划。