Astrakas Loukas G, De Novi Gianluca, Ottensmeyer Mark P, Pusatere Christian, Li Shasha, Moskowitz Michael A, Tzika A Aria
Medical Physics Laboratory, Faculty of Medicine, University of Ioannina, Ioannina 45110, Greece.
Medical Device and Simulation Laboratory, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.
Exp Ther Med. 2021 Mar;21(3):245. doi: 10.3892/etm.2021.9676. Epub 2021 Jan 22.
New rehabilitation strategies enabled by technological developments are challenging the prevailing concept of there being a limited window for functional recovery after stroke. In this study, we examined the utility of a robot-assisted therapy used in combination with a serious game as a rehabilitation and motor assessment tool in patients with chronic stroke. We evaluated 928 game rounds from 386 training sessions of 8 patients who had suffered an ischemic stroke affecting middle cerebral artery territory that incurred at least 6 months prior. Motor function was assessed with clinical motor scales, including the Fugl-Meyer upper extremity (FM UE) scale, Action Research Arm Test, Modified Ashworth scale and the Box and Blocks test. Robotic device output measures (mean force, force-position correlation) and serious game score elements (collisions, rewards and total score) were calculated. A total of 2 patients exhibited a marginal improvement after a 10-week training protocol according to the FM UE scale and an additional patient exhibited a significant improvement according to Box and Blocks test. Motor scales showed strong associations of robotic device parameters and game metrics with clinical motor scale scores, with the strongest correlations observed for the mean force (0.677<Ρ<0.869), followed by the number of collisions (-0.670<Ρ<-0.585). Linear regression analysis showed that these indices were independent predictors of motor scale scores. In conclusion, a robotic device linked to a serious game can be used by patients with chronic stroke and induce at least some clinical improvements in motor performance. Robotic device output parameters and game score elements associate strongly with clinical motor scales and have the potential to be used as predictors in models of rehabilitation progress.
技术发展带来的新康复策略正在挑战中风后功能恢复窗口期有限这一普遍观念。在本研究中，我们检验了将机器人辅助治疗与一款严肃游戏相结合作为慢性中风患者康复及运动评估工具的效用。我们评估了8例患者386次训练课程中的928轮游戏，这些患者均患有影响大脑中动脉区域的缺血性中风，且中风发生时间至少在6个月前。使用临床运动量表评估运动功能，包括Fugl-Meyer上肢（FM UE）量表、动作研究臂试验、改良Ashworth量表以及积木测试。计算机器人设备输出指标（平均力、力-位置相关性）和严肃游戏得分要素（碰撞、奖励和总分）。根据FM UE量表，共有2例患者在为期10周的训练方案后有轻微改善，另有1例患者根据积木测试有显著改善。运动量表显示，机器人设备参数和游戏指标与临床运动量表得分有很强的相关性，其中平均力的相关性最强（0.677<Ρ<0.869），其次是碰撞次数（-0.670<Ρ<-0.585）。线性回归分析表明，这些指标是运动量表得分的独立预测因素。总之，慢性中风患者可以使用与严肃游戏相连的机器人设备，并且该设备至少能在运动表现方面带来一些临床改善。机器人设备输出参数和游戏得分要素与临床运动量表密切相关，并且有潜力在康复进展模型中用作预测指标。
