TY - JOUR
T1 - Boosting the traditional physiotherapist approach for stroke spasticity using a sensorized ankle foot orthosis
T2 - A pilot study
AU - Tamburella, Federica
AU - Moreno, Juan C.
AU - Iosa, Marco
AU - Pisotta, Iolanda
AU - Cincotti, Febo
AU - Mattia, Donatella
AU - Pons, Jose L
AU - Molinari, Marco
N1 - Funding Information:
This study has been supported by the Italian Ministry of Health (RC08G), the European Commission in the Seventh Framework Program ICT-2009-247935 BETTER (Brain-Neural Computer Interaction for Evaluation and Testing of Physical Therapies in Stroke Rehabilitation of Gait Disorders), ICT-2013-611626 SYMBITRON (Symbiotic man–machine interactions in wearable exoskeletons to enhance mobility for paraplegics), and the GRANT “Regione Lazio – LR 13/2008 FILAS RU 2014-1033.”
PY - 2017
Y1 - 2017
N2 - Background: Spasticity is a motor disorder that is commonly treated manually by a physical therapist (PhT) stretching the muscles. Recent data on learning have demonstrated the importance of human-tohuman interaction in improving rehabilitation: cooperative motor behavior engages specific areas of the motor system compared with execution of a task alone. Objectives: We hypothesize that PhT-guided therapy that involves active collaboration with the patient (Pt) through shared biomechanical visual biofeedback (vBFB) positively impacts learning and performance by the Pt during ankle spasticity treatment. A sensorized ankle foot orthosis (AFO) was developed to provide online quantitative data of joint range of motion (ROM), angular velocity, and electromyographic activity to the PhT and Pt during the treatment of ankle spasticity. Methods: Randomized controlled clinical trial. Ten subacute stroke inpatients, randomized into experimental (EXP) and control (CTRL) groups, underwent six weeks of daily treatment. The EXP group was treated with an active AFO, and the CTRL group was given an inactive AFO. Spasticity, ankle ROM, ankle active and passive joint speed, and coactivation index (CI) were assessed at enrollment and after 15-30 sessions. Results: Spasticity and CI (p < 0.005) decreased significantly after training only in the EXP group, in association with a significant rise in active joint speed and active ROM (p < 0.05). Improvements in spasticity (p < 0.05), active joint speed (p < 0.001), and CI (p < 0.001) after treatment differed between the EXP and CTRL groups. Conclusions: PhT-Pt sharing of exercise information, provided by joint sensorization and vBFB, improved the efficacy of the conventional approach for treating ankle spasticity in subacute stroke Pts.
AB - Background: Spasticity is a motor disorder that is commonly treated manually by a physical therapist (PhT) stretching the muscles. Recent data on learning have demonstrated the importance of human-tohuman interaction in improving rehabilitation: cooperative motor behavior engages specific areas of the motor system compared with execution of a task alone. Objectives: We hypothesize that PhT-guided therapy that involves active collaboration with the patient (Pt) through shared biomechanical visual biofeedback (vBFB) positively impacts learning and performance by the Pt during ankle spasticity treatment. A sensorized ankle foot orthosis (AFO) was developed to provide online quantitative data of joint range of motion (ROM), angular velocity, and electromyographic activity to the PhT and Pt during the treatment of ankle spasticity. Methods: Randomized controlled clinical trial. Ten subacute stroke inpatients, randomized into experimental (EXP) and control (CTRL) groups, underwent six weeks of daily treatment. The EXP group was treated with an active AFO, and the CTRL group was given an inactive AFO. Spasticity, ankle ROM, ankle active and passive joint speed, and coactivation index (CI) were assessed at enrollment and after 15-30 sessions. Results: Spasticity and CI (p < 0.005) decreased significantly after training only in the EXP group, in association with a significant rise in active joint speed and active ROM (p < 0.05). Improvements in spasticity (p < 0.05), active joint speed (p < 0.001), and CI (p < 0.001) after treatment differed between the EXP and CTRL groups. Conclusions: PhT-Pt sharing of exercise information, provided by joint sensorization and vBFB, improved the efficacy of the conventional approach for treating ankle spasticity in subacute stroke Pts.
KW - Biofeedback
KW - Biomechanical
KW - Human-to-human interaction
KW - Rehabilitation
KW - Spasticity
KW - Stroke
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U2 - 10.1080/10749357.2017.1318340
DO - 10.1080/10749357.2017.1318340
M3 - Article
C2 - 28460597
AN - SCOPUS:85032256322
VL - 24
SP - 447
EP - 456
JO - Topics in Stroke Rehabilitation
JF - Topics in Stroke Rehabilitation
SN - 1074-9357
IS - 6
ER -