Date Presented 04/05/19
Primary Author and Speaker: Marissa Wuennemann
Contributing Authors: Heather Pepper Lane, Avrielle Peltz, Tomoko Kitago, Dylan Edwards
PURPOSE: Neurological injuries can result in upper extremity weakness, creating motor deficits that often persist long after the initial injury. These motor deficits require rehabilitative therapies that are often costly and labor-intensive for practitioners. Device-assisted therapies can provide high-dose, engaging treatment and may reduce motor impairment in a cost-effective manner (Veerbeek, Langbroek-Amersfoort, van Wegen, Meskers, & Kwakkel, 2017; Wagner et al., 2011). The purpose of this study is to determine the effect of dose and patient-to-staff ratio of Armeo®Spring therapy for individuals with chronic upper extremity paresis as a result of a neurological injury.
DESIGN: This is a quasi-experimental design. Participants were assigned to 1 of 4 groups that consisted of either 30 or 60 minutes of upper extremity Armeo®Spring therapy with a 1:1 or 2:1 patient to staff ratio. All study participants had unilateral upper extremity hemiparesis as a result of a neurological injury and were in the chronic stage (>6 months). Severity level was determined by the Upper Extremity Fugl-Meyer, inclusion criteria was a score between 7- 60.
METHOD: The Armeo®Spring device is an upper extremity exoskeleton (3 joints and 6 degrees of freedom) with integrated springs. It embraces the whole arm, from shoulder to hand, and counterbalances the weight of the patient’s arm, enhancing residual function and neuromuscular control, and assisting active movement across a large 3D workspace. The Armeo®Spring contains an extensive library of game-like movement exercises supported by a virtual reality training environment, while also providing immediate performance feedback. Participants received device-assisted upper extremity therapy with the Armeo®Spring 3 times per week for a total of 18 sessions over a 6 week period. Session duration was 30 minutes or 60 minutes dependent upon treatment condition. Outcome measures were assessed at baseline and post-training. The primary outcome measure was the Upper Extremity Fugl-Meyer (FM).
RESULTS: Current preliminary results: Study participants (n=30, aged 57.3 ± 16.5 yrs, 21/9 men/women) had chronic upper extremity paresis (6.5 ± 3.3 years post-stroke or other neurological injury). Participants in all conditions achieved significant reductions in arm impairment, measured using FM scores from baseline to post-training (3.1 ± 2.9, p<0.001). However, comparison of the changes in FM between 30 vs. 60 minute therapy sessions revealed no significant difference between these groups (3.1 ± 2.9 vs. 3.1 ± 3.0 pts). Similarly, there was no significant difference in changes in FM for the 1:1 vs. 2:1 patient to staff ratio (2.8 ± 2.8 vs. 3.6 ± 3.3 pts). Our preliminary results currently suggest that 6 weeks of Armeo®Spring therapy can achieve similar reductions in arm impairment with different durations of therapy (30 and 60 minutes) as well as with 1:1 or 2:1 patient:staff ratios.
CONCLUSION: Similar outcomes were reached between the 30 minute and 60 minute training groups with the Armeo®Spring. Overall, patients showed a reduction in upper extremity impairment at post-training, showing that device-assisted therapy can achieve small reductions in upper limb impairment with 18 sessions of 30 or 60 min durations; though, higher doses should be explored in future studies to explore whether there is a dose-response relationship. In addition, providing 2:1 staffing was feasible and achieved similar reductions in impairment, showing that device-assisted therapy can be a cost-effective, evidenced-based intervention strategy for upper limb motor recovery after a neurological injury.
References
Veerbeek, J. M., Langbroek-Amersfoort, A. C., van Wegen, E. E., Meskers, C.G., Kwakkel, G. (2017). Effects of robot assisted therapy for the upper limb after stroke. Neurorehabilitation and Neural Repair, 21(2), 107-121.
Wagner, T. H., Lo, A. C., Peduzzi, P., Bravata, D. M., Huang, G. D., Krebs, H. I., Ringer, R. J., Federman, D. G., Richards, L. G., Haselkorn, J. K., Wittenberg, G. F., Volpe, B. T., Bever, C. T., Duncan, P. W., Siroka, A., … Guarino, P. D. (2011). An economic analysis of robot-assisted therapy for long-term upper-limb impairment after stroke. Stroke, 42(9), 2630-2.
