Article

The Armeo Power, a rehabilitation exoskeleton that allows early
treatment of motor disabilities, provides intelligent arm support in a large
3-dimensional work space, thus enabling patients to perform intensive,
repetitive, and goal-oriented exercises. This device could efficiently induce new
connections and facilitate plasticity phenomena potentiation. Knowledge of the
potential brain plasticity reservoir after brain damage constitutes a
prerequisite for an optimal rehabilitation strategy. OBJECTIVE: To identify
potential neurophysiologic markers predicting the responsiveness of stroke
patients to upper limb robotic treatment. DESIGN: Prospective cohort study.
SETTING: Behavioral and Robotic Neurorehabilitation Laboratory of IRCCS Centro
Neurolesi Bonino-Pulejo, Messina, Italy. PATIENTS: We enrolled 35 patients who
had sustained a first-ever ischemic supratentorial stroke at least 2 months
before enrollment and had unilateral hemiplegia. METHODS: All patients underwent
40 Armeo Power training sessions that lasted 1 hour each (ie, 5 times a week for
8 weeks). MAIN OUTCOME MEASUREMENTS: We assessed the spasticity and motor
function of the upper limb by means of the Modified Ashworth scale and Fugl-Meyer
assessment, respectively. Moreover, we evaluated the cortical excitability and
plasticity potential of the bilateral primary motor areas in response to the
repetitive paired associative stimulation paradigm using transcranial magnetic
stimulation and Armeo Power kinematic parameters. RESULTS: The patients who
showed significant repetitive paired associative stimulation aftereffects at
baseline exhibited an evident increase of cortical plasticity in the affected
hemisphere (motor evoked potential amplitude increase, P = .03), a decrease of
interhemispheric inhibition (affected hemisphere cortical silent period duration
decrease, P = .01; unaffected hemisphere cortical silent period duration
increase, P = .004; repetitive paired associative stimulation aftereffect
increase, P = .008). Such findings were paralleled by clinical improvements
(Fugl-Meyer, P = .04) and Armeo Power kinematic improvements (elbow
flexion/extension, P = .02; shoulder range of movement, P = .002). CONCLUSIONS:
Our data suggest that use of Armeo Power may improve upper limb motor function
recovery as predicted by reshaping of cortical and transcallosal plasticity,
according to the baseline cortical excitability. LEVEL OF EVIDENCE: IV.
CI - Copyright (c) 2016 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS