Research

Open AccessArticle

Neurophysiological and Clinical Effects of Upper Limb Robot-Assisted Rehabilitation on Motor Recovery in Patients with Subacute Stroke: A Multicenter Randomized Controlled Trial Study Protocol

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Rocco Salvatore Calabrò

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the Italian PowerUPS-REHAB Study Group

Brain Sci. 2023, 13(4), 700; https://doi.org/10.3390/brainsci13040700 - 21 Apr 2023

Viewed by 753

Abstract

Background: The efficacy of upper limb (UL) robot-assisted therapy (RAT) on functional improvement after stroke remains unclear. However, recently published randomized controlled trials have supported its potential benefits in enhancing the activities of daily living, arm and hand function, and muscle strength. Task-specific [...] Read more.

Background: The efficacy of upper limb (UL) robot-assisted therapy (RAT) on functional improvement after stroke remains unclear. However, recently published randomized controlled trials have supported its potential benefits in enhancing the activities of daily living, arm and hand function, and muscle strength. Task-specific and high-intensity exercises are key points in facilitating motor re-learning in neurorehabilitation since RAT can provide an assisted-as-needed approach. This study aims to investigate the clinical effects of an exoskeleton robotic system for UL rehabilitation compared with conventional therapy (CT) in people with subacute stroke. As a secondary aim, we seek to identify patients’ characteristics, which can predict better recovery after UL-RAT and detects whether it could elicit greater brain stimulation. Methods: A total of 84 subacute stroke patients will be recruited from 7 Italian rehabilitation centers over 3 years. The patients will be randomly allocated to either CT (control group, CG) or CT plus UL-RT through an Armeo^®Power (Hocoma AG, CH, Volketswil, Switzerland) exoskeleton (experimental group, EG). A sample stratification based on distance since onset, DSO (DSO ≤ 30; DSO > 30), and Fugl–Meyer Assessment (FM)-UL (FM-UL ≤ 22; 22 < FM-UL ≤ 44) will be considered for the randomization. The outcomes will be recorded at baseline (T0), after 25 + 3 sessions of intervention (T1), and at 6 months post-stroke (T2). The motor functioning assessed by the FM-UL (0–66) will be considered the primary outcome. The clinical assessments will be set based on the International Classification of Function, Disability and Health (ICF). A patient satisfaction questionnaire will be evaluated in the EG at T1. A subgroup of patients will be evaluated at T0 and T1 via electroencephalography. Their brain electrical activity will be recorded during rest conditions with their eyes closed and open (5 min each). Conclusion: The results of this trial will provide an in-depth understanding of the efficacy of early UL-RAT through a whole arm exoskeleton and how it may relate to the neural plasticity process. The trial was registered at ClinicalTrial.gov with the registration identifier NCT04697368. Full article

(This article belongs to the Special Issue Robot-, Virtual Reality- and Sensor-Based Therapies Boosting Neuroplasticity in the Context of Motor and Cognitive Neurorehabilitation: Current State of the Art and Applications)

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Open AccessArticle

Feasibility of an Intelligent Algorithm Based on an Assist-as-Needed Controller for a Robot-Aided Gait Trainer (Lokomat) in Neurological Disorders: A Longitudinal Pilot Study

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Brain Sci. 2023, 13(4), 612; https://doi.org/10.3390/brainsci13040612 - 04 Apr 2023

Viewed by 660

Abstract

Most robotic gait assisted devices are designed to provide constant assistance during the training without taking into account each patient’s functional ability. The Lokomat offers an assist-as-needed control via the integrated exercise “Adaptive Gait Support” (AGS), which adapts the robotic support based on [...] Read more.

Most robotic gait assisted devices are designed to provide constant assistance during the training without taking into account each patient’s functional ability. The Lokomat offers an assist-as-needed control via the integrated exercise “Adaptive Gait Support” (AGS), which adapts the robotic support based on the patient’s abilities. The aims of this study were to examine the feasibility and characteristics of the AGS during long-term application. Ten patients suffering from neurological diseases underwent an 8-week Lokomat training with the AGS. They additionally performed conventional walking tests and a robotic force measurement. The difference between robotic support during adaptive and conventional training and the relationship between the robotic assessment and the conventional walking and force tests were examined. The results show that AGS is feasible during long-term application in a heterogeneous population. The support during AGS training in most of the gait phases was significantly lower than during conventional Lokomat training. A relationship between the robotic support level determined by the AGS and conventional walking tests was revealed. Moreover, combining the isometric force data and AGS data could divide patients into clusters, based on their ability to generate high forces and their level of motor control. AGS shows a high potential in assessing patients’ walking ability, as well as in providing challenging training, e.g., by automatically adjusting the robotic support throughout the whole gait cycle and enabling training at lower robotic support. Full article

(This article belongs to the Special Issue Robot-, Virtual Reality- and Sensor-Based Therapies Boosting Neuroplasticity in the Context of Motor and Cognitive Neurorehabilitation: Current State of the Art and Applications)

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Open AccessArticle

Can Virtual Reality Cognitive Rehabilitation Improve Executive Functioning and Coping Strategies in Traumatic Brain Injury? A Pilot Study

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Milva Veronica Castorina

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Andrea Santamato

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Angelo Quartarone

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Rocco Salvatore Calabrò

Brain Sci. 2023, 13(4), 578; https://doi.org/10.3390/brainsci13040578 - 29 Mar 2023

Viewed by 705

Abstract

Executive dysfunction is among the most common and disabling facets of cognitive impairment following traumatic brain injury (TBI), and may include deficits in reasoning, planning, mental flexibility, some aspects of attention and orientation, awareness and behavior. Rehabilitation programs based on cognitive-behavioral approaches to [...] Read more.

Executive dysfunction is among the most common and disabling facets of cognitive impairment following traumatic brain injury (TBI), and may include deficits in reasoning, planning, mental flexibility, some aspects of attention and orientation, awareness and behavior. Rehabilitation programs based on cognitive-behavioral approaches to retrain planning and problem-solving and other executive deficits may improve such cognitive dysfunction. The purpose of this study is to investigate the effects of non-immersive virtual reality-based training to improve executive abilities and to reduce anxiety and depression symptoms in patients with TBI. Twenty patients with moderate to severe TBI were enrolled at our Neurorehabilitation Unit and divided to receive either the standard cognitive training or the virtual reality (VR) based cognitive training using the virtual reality rehabilitation system (VRRS-Evo). Each group received the same amount of rehabilitative training, including ROT (Reality Orientation Therapy) and Executive Training (ET), but using a different approach, i.e., a paper and pencil and an advanced approach. All patients were evaluated with a specific psychometric battery before (T0) and after the end (T1) of each program. Comparing pre- and post- treatment scores, in the VR-CT group, we found statistically significant differences in all administered outcome measures for cognitive and executive functioning, i.e., MoCA (p < 0.005), FAB (p < 0.005), TMT-A (p < 0.005), TMT-B (p < 0.005), TMT-BA (p < 0.001), and mood, i.e., HRS-D (p < 0.008). In the Conventional cognitive training (C-CT) group, we found a significant improvement only in MoCA (p < 0.03), FAB (p < 0.02) and in TMT-BA (p < 0.01). Coping strategies also improved, with better results in the VR-CT group. Our results suggest that VR rehabilitation, using the VRRS system, may be a valuable and motivational approach to improve visuo-executive abilities and coping strategies as well as mood in chronic TBI patients. Full article

(This article belongs to the Special Issue Robot-, Virtual Reality- and Sensor-Based Therapies Boosting Neuroplasticity in the Context of Motor and Cognitive Neurorehabilitation: Current State of the Art and Applications)

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Open AccessArticle

Effect of Upper Limb Motor Rehabilitation on Cognition in Parkinson’s Disease: An Observational Study

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Ilaria Antonella Di Vico

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Andreas Waldner

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Mirko Filippetti

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Nicola Smania

Brain Sci. 2022, 12(12), 1684; https://doi.org/10.3390/brainsci12121684 - 08 Dec 2022

Viewed by 767

Abstract

Parkinson’s disease is characterized by motor and cognitive deficits that usually have an impact on quality of life and independence. To reduce impairment, various rehabilitation programs have been proposed, but their effects on both cognitive and motor aspects have not been systematically investigated. [...] Read more.

Parkinson’s disease is characterized by motor and cognitive deficits that usually have an impact on quality of life and independence. To reduce impairment, various rehabilitation programs have been proposed, but their effects on both cognitive and motor aspects have not been systematically investigated. Furthermore, most intervention is focused on lower limb treatment rather than upper limbs. In the present study, we investigated the effect of 3-week upper limb vibratory stimulation training on cognitive functioning in 20 individuals with Parkinson’s disease. We analyzed cognitive (Montreal Cognitive Assessment, Trial Making Test, Digit Symbol, Digit Span Forward and Backward and Alertness) and motor performance (Unified Parkinson’s Disease Rating Scale—part III; Disability of the Arm, Shoulder and Hand Questionnaire) before treatment, at the end of treatment and one month post treatment. After rehabilitation, a statistically significant improvement was observed in terms of global cognitive status, attention, global motor functioning and disability. The results suggest an impact of upper limb motor rehabilitation on cognition in Parkinson’s disease. Future studies on neuromotor interventions should investigate their effects on cognitive functioning to improve understanding of cognitive motor interaction in Parkinson’s disease. Full article

(This article belongs to the Special Issue Robot-, Virtual Reality- and Sensor-Based Therapies Boosting Neuroplasticity in the Context of Motor and Cognitive Neurorehabilitation: Current State of the Art and Applications)

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Open AccessArticle

Difference between the Effects of Peripheral Sensory Nerve Electrical Stimulation on the Excitability of the Primary Motor Cortex: Examination of the Combinations of Stimulus Frequency and Duration

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Brain Sci. 2022, 12(12), 1637; https://doi.org/10.3390/brainsci12121637 - 29 Nov 2022

Viewed by 772

Abstract

Peripheral sensory nerve electrical stimulation (PES) excites the primary motor cortex and is expected to improve motor dysfunction post-stroke. However, previous studies have reported a variety of stimulus frequencies and stimulus duration settings, and the effects of these different combinations on primary motor [...] Read more.

Peripheral sensory nerve electrical stimulation (PES) excites the primary motor cortex and is expected to improve motor dysfunction post-stroke. However, previous studies have reported a variety of stimulus frequencies and stimulus duration settings, and the effects of these different combinations on primary motor cortex excitability are not clear. We aimed to clarify the effects of different combinations of stimulus frequency and stimulus duration of PES on the excitation of primary motor cortex. Twenty-one healthy individuals (aged > 18 years, right-handed, and without a history of neurological or orthopedic disorders) were included. Each participant experienced three different stimulation frequencies (1, 10 and 50 Hz) and durations (20, 40 and 60 min). Motor-evoked potentials (MEPs) were recorded pre- and post-PES. The outcome measure was the change in primary motor cortex excitability using the MEP ratio. We used a D-optimal design of experiments and response surface analysis to define the optimal combination within nine different settings inducing more satisfying responses. The combination of stimulation frequency and stimulation time that maximized the desirability value was 10 Hz and 40 min, respectively. The results of this study may provide fundamental data for more minimally invasive and effective implementation of PES in patients with stroke. Full article

(This article belongs to the Special Issue Robot-, Virtual Reality- and Sensor-Based Therapies Boosting Neuroplasticity in the Context of Motor and Cognitive Neurorehabilitation: Current State of the Art and Applications)

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Open AccessArticle

Does Non-Immersive Virtual Reality Improve Attention Processes in Severe Traumatic Brain Injury? Encouraging Data from a Pilot Study

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Rocco Salvatore Calabrò

Brain Sci. 2022, 12(9), 1211; https://doi.org/10.3390/brainsci12091211 - 08 Sep 2022

Cited by 2 | Viewed by 1129

Abstract

Traumatic brain injury (TBI) is a sudden injury that causes damage to the brain. Rehabilitation therapies include specific training, such as attention process training (APT) programs using either standard or innovative approaches. The aim of this study is to evaluate the effects of [...] Read more.

Traumatic brain injury (TBI) is a sudden injury that causes damage to the brain. Rehabilitation therapies include specific training, such as attention process training (APT) programs using either standard or innovative approaches. The aim of this study is to evaluate the effects of a non-immersive virtual reality-based attention training to stimulate attention processes and mood in TBI patients. Thirty subjects with TBI were enrolled at the Neurorehabilitation Unit of the IRCCS Neurolesi Center and divided into either the Conventional Attention Process Training Group (C_APT: n = 15) or the Virtual-Based Attention Processes Training Group (VB_APT: n = 15), treated with the Virtual Reality Rehabilitation System (VRRS-Evo). All of the patients were evaluated with a specific psychometric battery before (T0) and after the end (T1) of each program. We found statistically significant differences between the two groups, in particular concerning global cognitive status (p < 0.02), attention processes (p < 0.03), depression symptoms (p < 0.04) and visual attention (p < 0.01). Experimental intragroup analysis showed great statistical significances in all psychometric tests, i.e., the Montreal Cognitive Assessment (p < 0.0006), Attention Matrices (p < 0.0007), the Hamilton Rating Scale-Depression (p < 0.004), the Trail Making Test-A (p < 0.0007), the Trail Making Test-B (p < 0.0007), and the Trail Making test-BA (p < 0.007). Our results suggest that non-immersive virtual reality may be a useful and effective approach for the attention processes recovery and mood of TBI patients, leading to better cognitive and behavioral outcomes. Full article

(This article belongs to the Special Issue Robot-, Virtual Reality- and Sensor-Based Therapies Boosting Neuroplasticity in the Context of Motor and Cognitive Neurorehabilitation: Current State of the Art and Applications)

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Open AccessArticle

Optimal Intervention Timing for Robotic-Assisted Gait Training in Hemiplegic Stroke

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Brain Sci. 2022, 12(8), 1058; https://doi.org/10.3390/brainsci12081058 - 10 Aug 2022

Cited by 1 | Viewed by 1321

Abstract

This study was designed to determine the best intervention time (acute, subacute, and chronic stages) for Walkbot robot-assisted gait training (RAGT) rehabilitation to improve clinical outcomes, including sensorimotor function, balance, cognition, and activities of daily living, in hemiparetic stroke patients. Thirty-six stroke survivors [...] Read more.

This study was designed to determine the best intervention time (acute, subacute, and chronic stages) for Walkbot robot-assisted gait training (RAGT) rehabilitation to improve clinical outcomes, including sensorimotor function, balance, cognition, and activities of daily living, in hemiparetic stroke patients. Thirty-six stroke survivors (acute stage group (ASG), n = 11; subacute stage group (SSG), n = 15; chronic stage group (CSG), n = 10) consistently received Walkbot RAGT for 30 min/session, thrice a week, for 4 weeks. Six clinical outcome variables, including the Fugl–Meyer Assessment (FMA), Berg Balance Scale (BBS), Trunk Impairment Scale (TIS), Modified Barthel Index (MBI), Modified Ashworth Scale (MAS), and Mini-Mental State Examination, were examined before and after the intervention. Significant differences in the FMA, BBS, TIS, and MBI were observed between the ASG and the SSG or CSG. A significant time effect was observed for all variables, except for the MAS, in the ASG and SSG, whereas significant time effects were noted for the FMA, BBS, and TIS in the CSG. Overall, Walkbot RAGT was more favorable for acute stroke patients than for those with subacute or chronic stroke. This provides the first clinical evidence for the optimal intervention timing for RAGT in stroke. Full article

(This article belongs to the Special Issue Robot-, Virtual Reality- and Sensor-Based Therapies Boosting Neuroplasticity in the Context of Motor and Cognitive Neurorehabilitation: Current State of the Art and Applications)

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Open AccessArticle

Robotic Verticalization plus Music Therapy in Chronic Disorders of Consciousness: Promising Results from a Pilot Study

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Rocco Salvatore Calabrò

Brain Sci. 2022, 12(8), 1045; https://doi.org/10.3390/brainsci12081045 - 06 Aug 2022

Cited by 4 | Viewed by 1261

Abstract

Background: Music stimulation is considered a valuable form of intervention in disorders of consciousness (DoC); for instance, verticalization may improve motor and cognitive recovery. Our purpose is to investigate the effects of a novel rehabilitative approach combining robotic verticalization training (RVT) with personalized [...] Read more.

Background: Music stimulation is considered a valuable form of intervention in disorders of consciousness (DoC); for instance, verticalization may improve motor and cognitive recovery. Our purpose is to investigate the effects of a novel rehabilitative approach combining robotic verticalization training (RVT) with personalized music stimulation in people with DoC. Methods: Sixteen subjects affected by minimally conscious state due to traumatic brain lesions who attended our Intensive Neuro-Rehabilitation Unit were enrolled in this randomized trial. They received either music robotic verticalization (MRV) using the Erigo device plus a personalized music playlist or only RVT without music stimuli. Each treatment was performed 2 times a week for 8 consecutive weeks in addition to standard neurorehabilitation. Results: We found significant improvements in all patients’ outcomes in the experimental group (who received MRV): Coma Recovery Scale-Revised (CRS-R) (p < 0.01), Level of Cognitive Functioning (LCF) (p < 0.02), Functional Independence Measure (FIM) (p < 0.03), Functional Communication Scale (FCS) (p < 0.007), Trunk Control Test (TCT) (p = 0.05). Significant differences between the two groups were also found in the main outcome measure CRS-R (p < 0.01) but not for TCT and FIM. Conclusions: Our study supports the safety and effectiveness of RVT with the Erigo device in chronic MCS, and the achievement of better outcomes when RVT is combined with music stimulation. Full article

(This article belongs to the Special Issue Robot-, Virtual Reality- and Sensor-Based Therapies Boosting Neuroplasticity in the Context of Motor and Cognitive Neurorehabilitation: Current State of the Art and Applications)

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Open AccessFeature PaperArticle

Gender Influences Virtual Reality-Based Recovery of Cognitive Functions in Patients with Traumatic Brain Injury: A Secondary Analysis of a Randomized Clinical Trial

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Rocco Salvatore Calabrò

Brain Sci. 2022, 12(4), 491; https://doi.org/10.3390/brainsci12040491 - 12 Apr 2022

Cited by 2 | Viewed by 1438

Abstract

The rehabilitation of cognitive deficits in individuals with traumatic brain injury is essential for promoting patients’ recovery and autonomy. Virtual reality (VR) training is a powerful tool for reaching this target, although the effectiveness of this intervention could be interfered with by several [...] Read more.

The rehabilitation of cognitive deficits in individuals with traumatic brain injury is essential for promoting patients’ recovery and autonomy. Virtual reality (VR) training is a powerful tool for reaching this target, although the effectiveness of this intervention could be interfered with by several factors. In this study, we evaluated if demographical and clinical variables could be related to the recovery of cognitive function in TBI patients after a well-validated VR training. One hundred patients with TBI were enrolled in this study and equally randomized into the Traditional Cognitive Rehabilitation Group (TCRG: n = 50) or Virtual Reality Training Group (VRTG: n = 50). The VRTG underwent a VRT with BTs-N, whereas the TCRG received standard cognitive treatment. All the patients were evaluated by a complete neuropsychological battery before (T0) and after the end of the training (T1). We found that the VR-related improvement in mood, as well as cognitive flexibility, and selective attention were influenced by gender. Indeed, females who underwent VR training were those showing better cognitive recovery. This study highlights the importance of evaluating gender effects in planning cognitive rehabilitation programs. The inclusion of different repetitions and modalities of VR training should be considered for TBI male patients. Full article

(This article belongs to the Special Issue Robot-, Virtual Reality- and Sensor-Based Therapies Boosting Neuroplasticity in the Context of Motor and Cognitive Neurorehabilitation: Current State of the Art and Applications)

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Open AccessArticle

When Two Is Better Than One: A Pilot Study on Transcranial Magnetic Stimulation Plus Muscle Vibration in Treating Chronic Pelvic Pain in Women

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Rocco Salvatore Calabrò

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Brain Sci. 2022, 12(3), 396; https://doi.org/10.3390/brainsci12030396 - 15 Mar 2022

Cited by 3 | Viewed by 1746

Abstract

Chronic pelvic pain syndrome (CPPS) affects about 4–16% of adult women, and about one-third of them require medical assistance due to severe symptoms. Repetitive transcranial magnetic stimulation (rTMS) over the supplementary motor area (SMA) has been shown to manage pain in refractory CPPS. [...] Read more.

Chronic pelvic pain syndrome (CPPS) affects about 4–16% of adult women, and about one-third of them require medical assistance due to severe symptoms. Repetitive transcranial magnetic stimulation (rTMS) over the supplementary motor area (SMA) has been shown to manage pain in refractory CPPS. Focal muscle vibration (FMV) has also been reported to relieve pelvic pain. The objective of this study was to assess the feasibility and effect of rTMS coupled with FMV to reduce pain in seven adult women with refractory CPPS. This pilot, open-labeled, prospective trial examined treatment by 5 Hz rTMS over SMA and 150 Hz FMV over the perineum, suprapubic, and sacrococcygeal areas, with one daily session for five consecutive days for three weeks. We assessed tolerance and subjective pain changes (as per visual analog scale, VAS) until one month post-treatment, with a primary endpoint at day 7. No patients experienced serious adverse effects or a significant increase in pain. Six out of seven patients experienced a VAS improvement of at least 10% at T7; three of these individuals experienced a VAS improvement of more than 30%. Overall, we found a significant VAS reduction of 15 points (95% CI 8.4–21.6) at T7 (t = 6.3, p = 0.001; ES = 2.3 (1.1–3.9)). Three of the women who demonstrated a significant VAS reduction at T7 retained such VAS improvement at T30. VAS decreased by six points (95% CI 1.3–10.7) at T30 (t = 3.1, p = 0.02; ES = 1.5 (0.2–2.6)). This coupled approach seems promising for pain management in adult women with refractory CPPS and paves the way for future randomized controlled trials. Full article

(This article belongs to the Special Issue Robot-, Virtual Reality- and Sensor-Based Therapies Boosting Neuroplasticity in the Context of Motor and Cognitive Neurorehabilitation: Current State of the Art and Applications)

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Review

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Open AccessReview

Sensor-Based Rehabilitation in Neurological Diseases: A Bibliometric Analysis of Research Trends

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Salvatore Facciorusso

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Stefania Spina

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Rajiv Reebye

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Andrea Turolla

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Rocco Salvatore Calabrò

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Pietro Fiore

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Andrea Santamato

Brain Sci. 2023, 13(5), 724; https://doi.org/10.3390/brainsci13050724 - 26 Apr 2023

Viewed by 445

Abstract

Background: As the field of sensor-based rehabilitation continues to expand, it is important to gain a comprehensive understanding of its current research landscape. This study aimed to conduct a bibliometric analysis to identify the most influential authors, institutions, journals, and research areas in [...] Read more.

Background: As the field of sensor-based rehabilitation continues to expand, it is important to gain a comprehensive understanding of its current research landscape. This study aimed to conduct a bibliometric analysis to identify the most influential authors, institutions, journals, and research areas in this field. Methods: A search of the Web of Science Core Collection was performed using keywords related to sensor-based rehabilitation in neurological diseases. The search results were analyzed with CiteSpace software using bibliometric techniques, including co-authorship analysis, citation analysis, and keyword co-occurrence analysis. Results: Between 2002 and 2022, 1103 papers were published on the topic, with slow growth from 2002 to 2017, followed by a rapid increase from 2018 to 2022. The United States was the most active country, while the Swiss Federal Institute of Technology had the highest number of publications among institutions. Sensors published the most papers. The top keywords included rehabilitation, stroke, and recovery. The clusters of keywords comprised machine learning, specific neurological conditions, and sensor-based rehabilitation technologies. Conclusions: This study provides a comprehensive overview of the current state of sensor-based rehabilitation research in neurological diseases, highlighting the most influential authors, journals, and research themes. The findings can help researchers and practitioners to identify emerging trends and opportunities for collaboration and can inform the development of future research directions in this field. Full article

(This article belongs to the Special Issue Robot-, Virtual Reality- and Sensor-Based Therapies Boosting Neuroplasticity in the Context of Motor and Cognitive Neurorehabilitation: Current State of the Art and Applications)

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Open AccessReview

Exploring the Potential of Immersive Virtual Reality in the Treatment of Unilateral Spatial Neglect Due to Stroke: A Comprehensive Systematic Review

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Brain Sci. 2022, 12(11), 1589; https://doi.org/10.3390/brainsci12111589 - 20 Nov 2022

Cited by 2 | Viewed by 1592

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The present review aims to explore the use of Immersive Virtual Reality (IVR) in the treatment of visual perception in Unilateral Spatial Neglect (USN) after a stroke. PubMed, Scopus, Embase and Pedro databases were searched, from inception to 1 February 2022. All studies [...] Read more.

The present review aims to explore the use of Immersive Virtual Reality (IVR) in the treatment of visual perception in Unilateral Spatial Neglect (USN) after a stroke. PubMed, Scopus, Embase and Pedro databases were searched, from inception to 1 February 2022. All studies that investigated the effect of IVR on USN, such as outcome in the stroke population, have been included. The current comprehensive systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and was registered in the PROSPERO database [CRD42022311284]. Methodological quality was assessed through JBI critical appraisal tool. A total of 436 articles were identified through the database searches. A total of 10 articles, with a heterogeneous study design, which involved 77 patients with USN with low-to-moderate methodological quality, have been selected. Five out the included studies tested usability of IVR for assessed or treated visual perception deficits in USN, comparing the results with 134 healthy subjects. In the rest of studies that tested IVR such as treatment, three showed statistical positive results (p < 0.05) in visual perception outcome. To date, the literature has suggested the potential benefits in the use of IVR for the treatment of visual perception disorders in USN. Interestingly, IVR motivates patients during the rehabilitation process improving compliance and interest. The heterogeneity in the studies’ design and in IVR treatments indicate the need of future investigations in the consideration of potentiality and low-cost of this technology. Full article

(This article belongs to the Special Issue Robot-, Virtual Reality- and Sensor-Based Therapies Boosting Neuroplasticity in the Context of Motor and Cognitive Neurorehabilitation: Current State of the Art and Applications)

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Open AccessReview

Efficacy of Overground Robotic Gait Training on Balance in Stroke Survivors: A Systematic Review and Meta-Analysis

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Brain Sci. 2022, 12(6), 713; https://doi.org/10.3390/brainsci12060713 - 31 May 2022

Cited by 3 | Viewed by 1661

Abstract

Strokes often lead to a deficit in motor control that contributes to a reduced balance function. Impairments in the balance function severely limit the activities of daily living (ADL) in stroke survivors. The present systematic review and meta-analysis primarily aims to explore the [...] Read more.

Strokes often lead to a deficit in motor control that contributes to a reduced balance function. Impairments in the balance function severely limit the activities of daily living (ADL) in stroke survivors. The present systematic review and meta-analysis primarily aims to explore the efficacy of overground robot-assisted gait training (o-RAGT) on balance recovery in individuals with stroke. In addition, the efficacy on ADL is also investigated. This systematic review identified nine articles investigating the effects of o-RAGT on balance, four of which also assessed ADL. The results of the meta-analysis suggest that o-RAGT does not increase balance and ADL outcomes more than conventional therapy in individuals after stroke. The data should not be overestimated due to the low number of studies included in the meta-analysis and the wide confidence intervals. Subgroup analyses to investigate the influence of participant’s characteristics and training dosage were not performed due to lack of data availability. Further well-designed randomized controlled trials are needed to investigate the efficacy of o-RAGT on balance in individuals with stroke. Full article

(This article belongs to the Special Issue Robot-, Virtual Reality- and Sensor-Based Therapies Boosting Neuroplasticity in the Context of Motor and Cognitive Neurorehabilitation: Current State of the Art and Applications)

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Open AccessEditor’s ChoiceSystematic Review

Balance Rehabilitation through Robot-Assisted Gait Training in Post-Stroke Patients: A Systematic Review and Meta-Analysis

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Alberto Loro

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Margherita Beatrice Borg

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Brain Sci. 2023, 13(1), 92; https://doi.org/10.3390/brainsci13010092 - 03 Jan 2023

Viewed by 1797

Abstract

Background: Balance impairment is a common disability in post-stroke survivors, leading to reduced mobility and increased fall risk. Robotic gait training (RAGT) is largely used, along with traditional training. There is, however, no strong evidence about RAGT superiority, especially on balance. This study [...] Read more.

Background: Balance impairment is a common disability in post-stroke survivors, leading to reduced mobility and increased fall risk. Robotic gait training (RAGT) is largely used, along with traditional training. There is, however, no strong evidence about RAGT superiority, especially on balance. This study aims to determine RAGT efficacy on balance of post-stroke survivors. Methods: PubMed, Cochrane Library, and PeDRO databases were investigated. Randomized clinical trials evaluating RAGT efficacy on post-stroke survivor balance with Berg Balance Scale (BBS) or Timed Up and Go test (TUG) were searched. Meta-regression analyses were performed, considering weekly sessions, single-session duration, and robotic device used. Results: A total of 18 trials have been included. BBS pre-post treatment mean difference is higher in RAGT-treated patients, with a pMD of 2.17 (95% CI 0.79; 3.55). TUG pre-post mean difference is in favor of RAGT, but not statistically, with a pMD of −0.62 (95%CI − 3.66; 2.43). Meta-regression analyses showed no relevant association, except for TUG and treatment duration (β = −1.019, 95% CI − 1.827; −0.210, p-value = 0.0135). Conclusions: RAGT efficacy is equal to traditional therapy, while the combination of the two seems to lead to better outcomes than each individually performed. Robot-assisted balance training should be the focus of experimentation in the following years, given the great results in the first available trials. Given the massive heterogeneity of included patients, trials with more strict inclusion criteria (especially time from stroke) must be performed to finally define if and when RAGT is superior to traditional therapy. Full article

(This article belongs to the Special Issue Robot-, Virtual Reality- and Sensor-Based Therapies Boosting Neuroplasticity in the Context of Motor and Cognitive Neurorehabilitation: Current State of the Art and Applications)

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Open AccessProtocol

Randomized Controlled Trial of Robot-Assisted Gait Training versus Therapist-Assisted Treadmill Gait Training as Add-on Therapy in Early Subacute Stroke Patients: The GAITFAST Study Protocol

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Brain Sci. 2022, 12(12), 1661; https://doi.org/10.3390/brainsci12121661 - 03 Dec 2022

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Abstract

The GAITFAST study (gait recovery in patients after acute ischemic stroke) aims to compare the effects of treadmill-based robot-assisted gait training (RTGT) and therapist-assisted treadmill gait training (TTGT) added to conventional physical therapy in first-ever ischemic stroke patients. GAITFAST (Clinicaltrials.gov identifier: NCT04824482) was [...] Read more.

The GAITFAST study (gait recovery in patients after acute ischemic stroke) aims to compare the effects of treadmill-based robot-assisted gait training (RTGT) and therapist-assisted treadmill gait training (TTGT) added to conventional physical therapy in first-ever ischemic stroke patients. GAITFAST (Clinicaltrials.gov identifier: NCT04824482) was designed as a single-blind single-center prospective randomized clinical trial with two parallel groups and a primary endpoint of gait speed recovery up to 6 months after ischemic stroke. A total of 120 eligible and enrolled participants will be randomly allocated (1:1) in TTGT or RTGT. All enrolled patients will undergo a 2-week intensive inpatient rehabilitation including TTGT or RTGT followed by four clinical assessments (at the beginning of inpatient rehabilitation 8–15 days after stroke onset, after 2 weeks, and 3 and 6 months after the first assessment). Every clinical assessment will include the assessment of gait speed and walking dependency, fMRI activation measures, neurological and sensorimotor impairments, and gait biomechanics. In a random selection (1:2) of the 120 enrolled patients, multimodal magnetic resonance imaging (MRI) data will be acquired and analyzed. This study will provide insight into the mechanisms behind poststroke gait behavioral changes resulting from intensive rehabilitation including assisted gait training (RTGT or TTGT) in early subacute IS patients. Full article

(This article belongs to the Special Issue Robot-, Virtual Reality- and Sensor-Based Therapies Boosting Neuroplasticity in the Context of Motor and Cognitive Neurorehabilitation: Current State of the Art and Applications)

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