Article

Robots that physically assist movement are increasingly used in
rehabilitation therapy after stroke, yet some studies suggest robotic assistance
discourages effort and reduces motor learning.
OBJECTIVE: To determine the
therapeutic effects of high and low levels of robotic assistance during finger
training. METHODS: We designed a protocol that varied the amount of robotic
assistance while controlling the number, amplitude, and exerted effort of
training movements. Participants (n = 30) with a chronic stroke and moderate
hemiparesis (average Box and Blocks Test 32 +/- 18 and upper extremity Fugl-Meyer
score 46 +/- 12) actively moved their index and middle fingers to targets to play
a musical game similar to GuitarHero 3 h/wk for 3 weeks. The participants were
randomized to receive high assistance (causing 82% success at hitting targets) or
low assistance (55% success). Participants performed ~8000 movements during 9
training sessions. RESULTS: Both groups improved significantly at the 1-month
follow-up on functional and impairment-based motor outcomes, on depression
scores, and on self-efficacy of hand function, with no difference between groups
in the primary endpoint (change in Box and Blocks). High assistance boosted
motivation, as well as secondary motor outcomes
(Fugl-Meyer and Lateral Pinch
Strength)-particularly for individuals with more severe finger motor deficits.
Individuals with impaired finger proprioception at baseline benefited less from
the training. CONCLUSIONS: Robot-assisted training can promote key psychological
outcomes known to modulate motor learning and retention. Furthermore, the
therapeutic effectiveness of robotic assistance appears to derive at least in
part from proprioceptive stimulation, consistent with a Hebbian plasticity model.

Langue : ANGLAIS