Robotic Rehabilitation in Spinal Cord Injury: A Pilot Study on End-Effectors and Neurophysiological Outcomes
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Annals of Biomedical Engineering (Ó 2020) https://doi.org/10.1007/s10439-020-02611-z
Original Article
Robotic Rehabilitation in Spinal Cord Injury: A Pilot Study on End-Effectors and Neurophysiological Outcomes ROCCO SALVATORE CALABRO`,1 SERENA FILONI,2 LUANA BILLERI,1 TINA BALLETTA,1 ANTONINO CANNAVO`,1 ANGELA MILITI,3 DEMETRIO MILARDI,4 LORIS PIGNOLO,5 and ANTONINO NARO1 1
IRCCS Centro Neurolesi Bonino Pulejo, via Palermo, Ctr. Casazza SS113, 98124 Messina, Italy; 2Padre Pio Foundation and Rehabilitation Centers, San Giovanni Rotondo, Italy; 3Stomatodental Centre, Messina, Italy; 4Department of Biomedical Dental Morphological and Functional Imaging Sciences, University of Messina, Messina, Italy; and 5Istituto S. Anna, Crotone, Italy (Received 18 April 2020; accepted 2 September 2020) Associate Editor Daniel Elson oversaw the review of this article.
Abstract—Robot-aided gait training (RAGT) has been implemented to provide patients with spinal cord injury (SCI) with a physiological limb activation during gait, cognitive engagement, and an appropriate stimulation of peripheral receptors, which are essential to entrain neuroplasticity mechanisms supporting functional recovery. We aimed at assessing whether RAGT by means of an endeffector device equipped with body weight support could improve functional ambulation in patients with subacute, motor incomplete SCI. In this pilot study, 15 patients were provided with six RAGT sessions per week for eight consecutive weeks. The outcome measures were muscle strength, ambulation, going upstairs, and disease burden. Furthermore, we estimated the activation patterns of lower limb muscles during RAGT by means of surface electromyography and the resting state networks’ functional connectivity (RSN-FC) before and after RAGT. Patients achieved a clinically significant improvement in the clinical outcome measures substantially up to six months post-treatment. These data were paralleled by an improvement in the stairclimbing cycle and a potentiating of frequency-specific and area-specific RSN-FC patterns. Therefore, RAGT, by means of an end-effector device equipped with body weight support, is promising in improving gait in patients with subacute, motor incomplete SCI, and it could produce additive benefit for the neuromuscular reeducation to gait in SCI when combined with conventional physiotherapy. Keywords—End-effector devices, Functional connectivity (FC), Resting state networks (RSN), Robot-aided gait training (RAGT), Spinal cord injury (SCI).
Address correspondence to Rocco Salvatore Calabro`, IRCCS Centro Neurolesi Bonino Pulejo, via Palermo, Ctr. Casazza SS113, 98124 Messina, Italy. Electronic mail: [email protected]
INTRODUCTION Spinal cord injury (SCI) is a major cause of disability often leading to significant gait impairment in terms of sensory-motor coordination, spasticity, impaired balance, and muscle weakness, up to wheelchair confinement.2 Intensive, repetitive, and task-oriented motor training is mandatory to maximize functional motor recovery and contain disabil
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