[PD Test]Robot-assisted rehab may be superior to usual therapy

A pilot systematic review of 33 articles on robot-assisted neuromotor rehabilitation for upper limbs and 30 for lower limbs showed a trend toward superior functional recovery compared to usual therapy—but was not statistically significant.

Investigators searched the electronic databases of MEDLINE via PubMed, Embase and Google Scholar for controlled trials with article in English from 2001 through 2010. Short and long-term motor control as well as motor strength was improved. Some cases of reduction in spasticity were found, but pain was unchanged.

The experimental intervention had no consistent impact on the performance of functional tasks such as activities of daily living (ADL) in multiple sclerosis, cerebral palsy or spinal cord injury.

With respect to the upper limb, results varied according to the greater intensity of the treatment as measured by the higher number of repetitions of task-specific exercises. In stroke patients, bilateral therapy resulted in better motor recovery than unilateral therapy. In patients undergoing therapy for lower limbs, achievement of the sitting position in the wheelchair during the early phase and achievement of the standing position later were seen.

Biofeedback, the use of instrumentation to make covert physiological processes overt, may be clinically applied to improve a patient’s motor control through “re-educating” that control using visual or audio feedback with the help of electromyelogram, positional and force parameters “in real time.”

Precise mechanisms are unclear, but previous review of studies suggested that new pathways may develop or an auxiliary loop recruits existing pathways that are unused or underused in the execution of motor commands. [J Neuroeng Rehabil 2006; doi:10.1186/1743-0003-3-11]

Continued training could then later establish “new sensory engrams” that would allow the patient to later engage in improved motor activity without feedback, according to the review. One of the current developments in the area of biofeedback for neurorehabilitation is a shift from static to task-oriented feedback, which may have an advantage in improving functional ADL tasks.

In the same review on biofeedback therapy, its limitation was recognized in patients with severe motor deficits, with patients unable to initiate any functional movement at all, leaving them with no biofeedback to capitalize on. Rehabilitation robots address this issue by providing mechanical assistance for movement. The review awaited new studies that will pursue the combination of robotics and advanced biofeedback as an approach for sensorimotor rehabilitation.