Open AccessKinematic Parameters for Tracking Patient Progress during Upper Limb Robot-Assisted Rehabilitation: An Observational Study on Subacute Stroke Subjects
Author(s) -
Michela Goffredo,
Stefano Mazzoleni,
Annalisa Gison,
Francesco Infarinato,
Sanaz Pournajaf,
Daniele Galafate,
Maurizio Agosti,
Federico Posteraro,
Marco Franceschini
Publication year - 2019
Publication title -
applied bionics and biomechanics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.397
H-Index - 23
eISSN - 1754-2103
pISSN - 1176-2322
DOI - 10.1155/2019/4251089
Subject(s) - kinematics , physical medicine and rehabilitation , wilcoxon signed rank test , rehabilitation , trajectory , observational study , bonferroni correction , computer science , task (project management) , stroke (engine) , minimal clinically important difference , physical therapy , medicine , artificial intelligence , engineering , mathematics , surgery , statistics , randomized controlled trial , mechanical engineering , physics , systems engineering , classical mechanics , pathology , astronomy , mann–whitney u test
Background Upper limb robot-assisted therapy (RT) provides intensive, repetitive, and task-specific treatment, and its efficacy for stroke survivors is well established in literature. Biomechanical data from robotic devices has been widely employed for patient's assessment, but rarely it has been analysed for tracking patient progress during RT. The goal of this retrospective study is to analyse built-in kinematic data registered by a planar end-effector robot for assessing the time course of motor recovery and patient's workspace exploration skills. A comparison of subjects having mild and severe motor impairment has been also conducted. For that purpose, kinematic data recorded by a planar end-effector robot have been processed for investigating how motor performance in executing point-to-point trajectories with different directions changes during RT.Methods Observational retrospective study of 68 subacute stroke patients who conducted 20 daily sessions of upper limb RT with the InMotion 2.0 (Bionik Laboratories, USA): planar point-to-point reaching tasks with an “assist as needed” strategy. The following kinematic parameters (KPs) were computed for each subject and for each point-to-point trajectory executed during RT: movement accuracy, movement speed, number of peak speed, and task completion time. The Wilcoxon signed-rank tests were used with clinical outcomes. the Friedman test and post hoc Conover's test (Bonferroni's correction) were applied to KPs. A secondary data analysis has been conducted by comparing patients having different severities of motor impairment. The level of significance was set at p value < 0.05.Results At the RT onset, the movements were less accurate and smoothed, and showed higher times of execution than those executed at the end of treatment. The analysis of the time course of KPs highlighted that RT seems to improve the motor function mainly in the first sessions of treatment: most KPs show significant intersession differences during the first 5/10 sessions. Afterwards, no further significant variations occurred. The ability to perform movements away from the body and from the hemiparetic side remains more challenging. The results obtained from the data stratification show significant differences between subjects with mild and severe motor impairment.Conclusion Significant improvements in motor performance were registered during the time course of upper limb RT in subacute stroke patients. The outcomes depend on movement direction and motor impairment and pave the way to optimize healthcare resources and to design patient-tailored rehabilitative protocols.