%0 Journal Article
%T Haptic-Based Neurorehabilitation in Poststroke Patients: A Feasibility Prospective Multicentre Trial for Robotics Hand Rehabilitation
%A Andrea Turolla
%A Omar A. Daud Albasini
%A Roberto Oboe
%A Michela Agostini
%A Paolo Tonin
%A Stefano Paolucci
%A Giorgio Sandrini
%A Annalena Venneri
%A Lamberto Piron
%J Computational and Mathematical Methods in Medicine
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/895492
%X Background. Haptic robots allow the exploitation of known motor learning mechanisms, representing a valuable option for motor treatment after stroke. The aim of this feasibility multicentre study was to test the clinical efficacy of a haptic prototype, for the recovery of hand function after stroke. Methods. A prospective pilot clinical trial was planned on 15 consecutive patients enrolled in 3 rehabilitation centre in Italy. All the framework features of the haptic robot (e.g., control loop, external communication, and graphic rendering for virtual reality) were implemented into a real-time MATLAB/Simulink environment, controlling a five-bar linkage able to provide forces up to 20£¿[N] at the end effector, used for finger and hand rehabilitation therapies. Clinical (i.e., Fugl-Meyer upper extremity scale; nine hold pegboard test) and kinematics (i.e., time; velocity; jerk metric; normalized jerk of standard movements) outcomes were assessed before and after treatment to detect changes in patients' motor performance. Reorganization of cortical activation was detected in one patient by fMRI. Results and Conclusions. All patients showed significant improvements in both clinical and kinematic outcomes. Additionally, fMRI results suggest that the proposed approach may promote a better cortical activation in the brain. 1. Background Hand and finger dexterities are fundamental for many activities carried out by a person in order to be independent. Stroke can reduce motor function due to the resulting death of associated brain cells. Stroke leads to permanent neurological impairment in at least 12.6 million people worldwide [1, 2], and in up to 75% of the subjects, motor deficits involve the upper limb [3]. Nowadays, almost all the activities that deal with physical therapy and training tools for rehabilitation have focused on relearning movements of the abilities that the patients had stroke before. Currently, traditional rehabilitative interventions are mainly focused on the passive facilitation of isolated movements or on the promotion of alternative movements to those used before motor diseases [4, 5]. These need to emerge as a consequence of the increasing incidence of stroke patients and the related costs associated to rehabilitation care. Recent findings from movement neuroscience demonstrated that the human neuromuscular system presents use-dependent plasticity, intended as changes in the pattern of neurons¡¯ connectivity [6], not only in healthy but also in neurologically diseased patients, so poststroke patients can experience significant benefits if
%U http://www.hindawi.com/journals/cmmm/2013/895492/