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Clin Neurophysiol. 2019 May;130(5):767-780. doi: 10.1016/j.clinph.2019.02.013. Epub 2019 Mar 15.

Does hand robotic rehabilitation improve motor function by rebalancing interhemispheric connectivity after chronic stroke? Encouraging data from a randomised-clinical-trial.

Author information

1
IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy. Electronic address: salbro77@tiscali.it.
2
IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy.
3
Otorhinolaryngoiatry Unit, University of Messina, Messina, Italy.
4
Fondazione Centri di Riabilitazione Padre Pio Onlus, San Giovanni Rotondo, FG, Italy.

Abstract

OBJECTIVE:

The objective of this study was the evaluation of the clinical and neurophysiological effects of intensive robot-assisted hand therapy compared to intensive occupational therapy in the chronic recovery phase after stroke.

METHODS:

50 patients with a first-ever stroke occurred at least six months before, were enrolled and randomised into two groups. The experimental group was provided with the Amadeo™ hand training (AHT), whereas the control group underwent occupational therapist-guided conventional hand training (CHT). Both of the groups received 40 hand training sessions (robotic and conventional, respectively) of 45 min each, 5 times a week, for 8 consecutive weeks. All of the participants underwent a clinical and electrophysiological assessment (task-related coherence, TRCoh, and short-latency afferent inhibition, SAI) at baseline and after the completion of the training.

RESULTS:

The AHT group presented improvements in both of the primary outcomes (Fugl-Meyer Assessment for of Upper Extremity and the Nine-Hole Peg Test) greater than CHT (both p < 0.001). These results were paralleled by a larger increase in the frontoparietal TRCoh in the AHT than in the CHT group (p < 0.001) and a greater rebalance between the SAI of both the hemispheres (p < 0.001).

CONCLUSIONS:

These data suggest a wider remodelling of sensorimotor plasticity and interhemispheric inhibition between sensorimotor cortices in the AHT compared to the CHT group.

SIGNIFICANCE:

These results provide neurophysiological support for the therapeutic impact of intensive robot-assisted treatment on hand function recovery in individuals with chronic stroke.

KEYWORDS:

Amadeo™; Frontoparietal connectivity; Hand rehabilitation; Sensorimotor plasticity

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