Robot-, Virtual Reality- and Sensor-Based Therapies Boosting Neuroplasticity in the Context of Motor and Cognitive Neurorehabilitation: Current State of the Art and Applications

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neurorehabilitation".

Deadline for manuscript submissions: closed (25 September 2023) | Viewed by 35157

Special Issue Editors

IRCCS Foundation Santa Lucia | Clinical Laboratory of Experimental Neurorehabilitation, 00179 Roma, Italy
Interests: stroke; neurorehabilitation; cerebrovascular diseases; prognostic factors; cognitive outcomes
Special Issues, Collections and Topics in MDPI journals
Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
Interests: neurorehabilitation; stroke; neural plasticity; Huntington's disease; cognitive rehabilitation; robotics and new technologies
Laboratory for the Study of Mind and Action in Rehabilitation Technologies – Smart Lab, Santa Lucia Foundation IRCCS, Via Ardeatina 306, 00179 Rome, Italy
Interests: neuroscience; neurorehabilitation; motor control; neuropsychology; psychometry
Special Issues, Collections and Topics in MDPI journals
Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy
Interests: prefrontal cortex; cognitive neuroscience; brain mapping; neurology; cognitive science; artificial intelligence
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Neurological sequelae are the leading causes of disability in all industrialized countries. Conventional rehabilitation usually allows a small proportion of patients suffering from neurological disabilities to recover independent walking or functional grasping, and other activities of daily living. For these reasons, an increasing number of research studies and randomized clinical trials are pursuing the use of new technologies to improve the efficacy of rehabilitation. Several Cochrane revisions have been created and updated over the years regarding robot and electromechanic-assisted therapy and virtual reality use specifically in subjects affected by stroke. They have become more usable and widespread every year, thanks to new principles of neuroscience and to technological innovations translated into clinical practice. However, despite their diffusion in neurorehabilitation and despite the fact that we are now ready to prepare a dialogue based on dialectics and knowledge superior to that of twenty years ago, many questions remain unanswered.

In particular, the disputes about their efficacy, together with the high purchase cost for most of these devices, the absence of clear and univocal guidelines about better dosages to use and parameter values to select, and somewhat diffuse scepticism of some members of the rehabilitation teams, may limit their use in clinical settings.

Finally, the majority of the available studies and clinical indications regard stroke and multiple sclerosis, despite the fact that they might even benefit other pathologies, such as Parkinson’s disease, traumatic brain injuries, spinal cord injuries and other brain degenerative diseases.

This Special Issue aims to provide an overview on the use of new technologies in the neurorehabilitation of people with motor and cognitive disabilities stemming from central nervous systems diseases.

Dr. Giovanni Morone
Dr. Stefano Paolucci
Prof. Dr. Irene Ciancarelli
Prof. Dr. Marco Iosa
Dr. Antonio Cerasa
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Published Papers (17 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Editorial

Jump to: Research, Review, Other

3 pages, 210 KiB  
Editorial
Robot- and Technology-Boosting Neuroplasticity-Dependent Motor-Cognitive Functional Recovery: Looking towards the Future of Neurorehabilitation
by Giovanni Morone, Marco Iosa, Rocco Salvatore Calabrò, Antonio Cerasa, Stefano Paolucci, Gabriella Antonucci and Irene Ciancarelli
Brain Sci. 2023, 13(12), 1687; https://doi.org/10.3390/brainsci13121687 - 07 Dec 2023
Viewed by 686
Abstract
The sequelae of neurological disorders are the leading causes of disability in all industrialized countries [...] Full article

Research

Jump to: Editorial, Review, Other

15 pages, 2178 KiB  
Article
Neurorehabilitation including Virtual-Reality-Based Balance Therapy: Factors Associated with Training Response
by Evelyne Wiskerke, Jan Kool, Roger Hilfiker, Martin Sattelmayer and Geert Verheyden
Brain Sci. 2024, 14(3), 263; https://doi.org/10.3390/brainsci14030263 - 07 Mar 2024
Viewed by 614
Abstract
Background: Virtual reality (VR) therapy is increasingly used and has shown encouraging effects. Yet, it is unknown which patients respond best to VR-based balance therapy as part of neurorehabilitation. Methods: Data from 30 persons with stroke and 51 persons with multiple sclerosis who [...] Read more.
Background: Virtual reality (VR) therapy is increasingly used and has shown encouraging effects. Yet, it is unknown which patients respond best to VR-based balance therapy as part of neurorehabilitation. Methods: Data from 30 persons with stroke and 51 persons with multiple sclerosis who performed three to four weeks of VR-based balance therapy during in-patient rehabilitation were analysed. Participants were divided into responders and nonresponders based on achievement of the minimal clinically important difference in functional balance post intervention. Measures of balance, trunk function, mobility, gait, motivation, and exergame parameters were compared between groups. Results: Post intervention, all clinical measurements significantly improved (p < 0.05; effect size: 0.45–0.59). Participants that achieved the minimal clinically important difference in functional balance (n = 49; 60%) had significantly lower preintervention functional and dynamic balance (median(IQR): 39(27–46) versus 45(37–50); p = 0.02 and 11(6–15) versus 16(11–18); p = 0.03). They spent less time on higher difficulty exercises (11(8–17) versus 14.5(10–12); p = 0.03) and demonstrated increased motivation over time compared with nonresponders (1(−1–5) versus −2(−7–3); p = 0.03). Conclusion: Lower baseline balance ability, spending more time on adequately challenging exercises, and increased motivation potentially influence response to therapy. These factors can support the personalisation of VR-based balance therapy. Full article
Show Figures

Figure 1

12 pages, 1383 KiB  
Article
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
by Sanaz Pournajaf, Giovanni Morone, Sofia Straudi, Michela Goffredo, Maria Rosaria Leo, Rocco Salvatore Calabrò, Giorgio Felzani, Stefano Paolucci, Serena Filoni, Andrea Santamato, Marco Franceschini and the Italian PowerUPS-REHAB Study Group
Brain Sci. 2023, 13(4), 700; https://doi.org/10.3390/brainsci13040700 - 21 Apr 2023
Cited by 6 | Viewed by 2049
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
Show Figures

Figure 1

18 pages, 3271 KiB  
Article
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
by Caroline Laszlo, Daniele Munari, Serena Maggioni, Deborah Knechtle, Peter Wolf and Dino De Bon
Brain Sci. 2023, 13(4), 612; https://doi.org/10.3390/brainsci13040612 - 04 Apr 2023
Cited by 1 | Viewed by 1815
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
Show Figures

Figure 1

13 pages, 785 KiB  
Article
Can Virtual Reality Cognitive Rehabilitation Improve Executive Functioning and Coping Strategies in Traumatic Brain Injury? A Pilot Study
by Rosaria De Luca, Mirjam Bonanno, Angela Marra, Carmela Rifici, Patrizia Pollicino, Angelo Caminiti, Milva Veronica Castorina, Andrea Santamato, Angelo Quartarone and Rocco Salvatore Calabrò
Brain Sci. 2023, 13(4), 578; https://doi.org/10.3390/brainsci13040578 - 29 Mar 2023
Cited by 4 | Viewed by 2241
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
Show Figures

Figure 1

12 pages, 546 KiB  
Article
Effect of Upper Limb Motor Rehabilitation on Cognition in Parkinson’s Disease: An Observational Study
by Valentina Varalta, Elisa Evangelista, Anna Righetti, Giovanni Morone, Stefano Tamburin, Alessandro Picelli, Cristina Fonte, Michele Tinazzi, Ilaria Antonella Di Vico, Andreas Waldner, Mirko Filippetti and Nicola Smania
Brain Sci. 2022, 12(12), 1684; https://doi.org/10.3390/brainsci12121684 - 08 Dec 2022
Cited by 2 | Viewed by 1442
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
Show Figures

Figure 1

8 pages, 1106 KiB  
Article
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
by Masaaki Sato, Hitoshi Mutai, Jun Iwanami, Anna Noji, Sayaka Sugimoto, Kana Ozawa and Akira Sagari
Brain Sci. 2022, 12(12), 1637; https://doi.org/10.3390/brainsci12121637 - 29 Nov 2022
Viewed by 1326
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
Show Figures

Figure 1

12 pages, 714 KiB  
Article
Does Non-Immersive Virtual Reality Improve Attention Processes in Severe Traumatic Brain Injury? Encouraging Data from a Pilot Study
by Rosaria De Luca, Mirjam Bonanno, Carmela Rifici, Patrizia Pollicino, Angelo Caminiti, Giovanni Morone and Rocco Salvatore Calabrò
Brain Sci. 2022, 12(9), 1211; https://doi.org/10.3390/brainsci12091211 - 08 Sep 2022
Cited by 8 | Viewed by 1810
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
Show Figures

Figure 1

12 pages, 783 KiB  
Article
Optimal Intervention Timing for Robotic-Assisted Gait Training in Hemiplegic Stroke
by Lingchao Xie, Bu Hyun Yoon, Chanhee Park and Joshua (Sung) H. You
Brain Sci. 2022, 12(8), 1058; https://doi.org/10.3390/brainsci12081058 - 10 Aug 2022
Cited by 3 | Viewed by 2074
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
Show Figures

Figure 1

11 pages, 738 KiB  
Article
Robotic Verticalization plus Music Therapy in Chronic Disorders of Consciousness: Promising Results from a Pilot Study
by Rosaria De Luca, Mirjam Bonanno, Giuliana Vermiglio, Giovanni Trombetta, Ersilia Andidero, Angelo Caminiti, Patrizia Pollicino, Carmela Rifici and Rocco Salvatore Calabrò
Brain Sci. 2022, 12(8), 1045; https://doi.org/10.3390/brainsci12081045 - 06 Aug 2022
Cited by 5 | Viewed by 2035
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
Show Figures

Figure 1

9 pages, 900 KiB  
Article
Gender Influences Virtual Reality-Based Recovery of Cognitive Functions in Patients with Traumatic Brain Injury: A Secondary Analysis of a Randomized Clinical Trial
by Roberta Bruschetta, Maria Grazia Maggio, Antonino Naro, Irene Ciancarelli, Giovanni Morone, Francesco Arcuri, Paolo Tonin, Gennaro Tartarisco, Giovanni Pioggia, Antonio Cerasa and Rocco Salvatore Calabrò
Brain Sci. 2022, 12(4), 491; https://doi.org/10.3390/brainsci12040491 - 12 Apr 2022
Cited by 4 | Viewed by 2166
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
Show Figures

Figure 1

13 pages, 695 KiB  
Article
When Two Is Better Than One: A Pilot Study on Transcranial Magnetic Stimulation Plus Muscle Vibration in Treating Chronic Pelvic Pain in Women
by Rocco Salvatore Calabrò, Luana Billeri, Bruno Porcari, Loris Pignolo and Antonino Naro
Brain Sci. 2022, 12(3), 396; https://doi.org/10.3390/brainsci12030396 - 15 Mar 2022
Cited by 3 | Viewed by 2590
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
Show Figures

Figure 1

Review

Jump to: Editorial, Research, Other

20 pages, 17724 KiB  
Review
Sensor-Based Rehabilitation in Neurological Diseases: A Bibliometric Analysis of Research Trends
by Salvatore Facciorusso, Stefania Spina, Rajiv Reebye, Andrea Turolla, Rocco Salvatore Calabrò, Pietro Fiore and Andrea Santamato
Brain Sci. 2023, 13(5), 724; https://doi.org/10.3390/brainsci13050724 - 26 Apr 2023
Cited by 4 | Viewed by 1385
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
Show Figures

Figure 1

15 pages, 1361 KiB  
Review
Exploring the Potential of Immersive Virtual Reality in the Treatment of Unilateral Spatial Neglect Due to Stroke: A Comprehensive Systematic Review
by Alex Martino Cinnera, Alessio Bisirri, Ilaria Chioccia, Enza Leone, Irene Ciancarelli, Marco Iosa, Giovanni Morone and Valeria Verna
Brain Sci. 2022, 12(11), 1589; https://doi.org/10.3390/brainsci12111589 - 20 Nov 2022
Cited by 7 | Viewed by 2880
Abstract
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
Show Figures

Graphical abstract

18 pages, 1951 KiB  
Review
Efficacy of Overground Robotic Gait Training on Balance in Stroke Survivors: A Systematic Review and Meta-Analysis
by Matteo Lorusso, Marco Tramontano, Matteo Casciello, Andrea Pece, Nicola Smania, Giovanni Morone and Federica Tamburella
Brain Sci. 2022, 12(6), 713; https://doi.org/10.3390/brainsci12060713 - 31 May 2022
Cited by 9 | Viewed by 2506
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
Show Figures

Figure 1

Other

14 pages, 1945 KiB  
Systematic Review
Balance Rehabilitation through Robot-Assisted Gait Training in Post-Stroke Patients: A Systematic Review and Meta-Analysis
by Alberto Loro, Margherita Beatrice Borg, Marco Battaglia, Angelo Paolo Amico, Roberto Antenucci, Paolo Benanti, Michele Bertoni, Luciano Bissolotti, Paolo Boldrini, Donatella Bonaiuti, Thomas Bowman, Marianna Capecci, Enrico Castelli, Loredana Cavalli, Nicoletta Cinone, Lucia Cosenza, Rita Di Censo, Giuseppina Di Stefano, Francesco Draicchio, Vincenzo Falabella, Mirko Filippetti, Silvia Galeri, Francesca Gimigliano, Mauro Grigioni, Marco Invernizzi, Johanna Jonsdottir, Carmelo Lentino, Perla Massai, Stefano Mazzoleni, Stefano Mazzon, Franco Molteni, Sandra Morelli, Giovanni Morone, Antonio Nardone, Daniele Panzeri, Maurizio Petrarca, Federico Posteraro, Andrea Santamato, Lorenza Scotti, Michele Senatore, Stefania Spina, Elisa Taglione, Giuseppe Turchetti, Valentina Varalta, Alessandro Picelli and Alessio Baricichadd Show full author list remove Hide full author list
Brain Sci. 2023, 13(1), 92; https://doi.org/10.3390/brainsci13010092 - 03 Jan 2023
Cited by 5 | Viewed by 3888
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
Show Figures

Figure 1

14 pages, 592 KiB  
Protocol
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
by Barbora Kolářová, Daniel Šaňák, Petr Hluštík and Petr Kolář
Brain Sci. 2022, 12(12), 1661; https://doi.org/10.3390/brainsci12121661 - 03 Dec 2022
Cited by 1 | Viewed by 1585
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
Back to TopTop