Article

High intensity and early initiation of rehabilitation have been
extensively demonstrated to enhance neural plasticity and motor recovery after
stroke. However, the optimal duration of rehabilitation programs in order to have
the highest impact on motor outcomes has not been established. OBJECTIVES: To
evaluate motor outcomes in subacute stroke survivors with moderate to severe
upper limb paresis over an extended period of rehabilitation consisting of usual
care augmented with a large number of upper limb robot-assisted sessions (54 +/-
13 sessions). METHODS: Retrospective study in 10 inpatients. RESULTS: The results
showed a gradual decrease in motor and functional impairments throughout the
training period with a clinically meaningful increase in the
Fugl-Meyer
Assessment scores and in the Motor Status Scores (1st vs 37th day of the
training, FMA,+ 48%, p = 0.018, MSS,+ 64%, p = 0.012; 37th vs. 79th day, FMA,+
23%, p = 0.012, MSS,+ 30%, p = 0.017). In addition, there were improvements in
hand kinematics recorded by the robot during a pointing task,
with quantitative
improvement (1st vs 40th day, movement efficacy,+ 97%, p = 0.0499; hand
velocity,+ 335%, p = 0.013) prior to qualitative improvement (1st vs 80th day,
number of hand trajectory reversals, -50%, p = 0.028; root mean square error of
the trajectory/linear displacement, -52%, p = 0.059). CONCLUSIONS: Although this
study was a retrospective analysis of a small sample of patients, the results
suggested that a prolonged period of intensive upper limb rehabilitation,
including robot-assisted training incorporated into a multidisciplinary program
throughout the subacute phase after stroke resulted in significant improvements
in patients with moderate to severe motor impairments.

Langue : ANGLAIS