Authors: Turolla, Andrea | Kiper, Pawel | Mazzarotto, Deborah | Cecchi, Francesca | Colucci, Mariele | D’Avenio, Giuseppe | Facciorusso, Salvatore | Gatti, Roberto | Giansanti, Daniele | Iosa, Marco | Bonaiuti, Donatella | Boldrini, Paolo | Mazzoleni, Stefano | Posteraro, Federico | Benanti, Paolo | Castelli, Enrico | Draicchio, Francesco | Falabella, Vincenzo | Galeri, Silvia | Gimigliano, Francesca | Grigioni, Mauro | Mazzon, Stefano | Morone, Giovanni | Petrarca, Maurizio | Picelli, Alessandro | Senatore, Michele | Turchetti, Giuseppe | Molteni, Franco
Article Type: Review Article
Abstract: BACKGROUND: Robot-based treatments are developing in neurorehabilitation settings. Recently, the Italian National Health Systems recognized robot-based rehabilitation as a refundable service. Thus, the Italian neurorehabilitation community promoted a national consensus on this topic. OBJECTIVE: To conceptualize undisclosed perspectives for research and applications of robotics for neurorehabilitation, based on a qualitative synthesis of reference theoretical models. METHODS: A scoping review was carried out based on a specific question from the consensus Jury. A foreground search strategy was developed on theoretical models (context) of robot-based rehabilitation (exposure), in neurological patients (population). PubMed and EMBASE® databases were searched and studies on theoretical models …of motor control, neurobiology of recovery, human-robot interaction and economic sustainability were included, while experimental studies not aimed to investigate theoretical frameworks, or considering prosthetics, were excluded. RESULTS: Overall, 3699 records were screened and finally 9 papers included according to inclusion and exclusion criteria. According to the population investigated, structured information on theoretical models and indications for future research was summarized in a synoptic table. CONCLUSION: The main indication from the Italian consensus on robotics in neurorehabilitation is the priority to design research studies aimed to investigate the role of robotic and electromechanical devices in promoting neuroplasticity. Show more
Keywords: Robot-assisted rehabilitation, theoretical models, neurorehabilitation, Consensus Conference
DOI: 10.3233/NRE-220160
Citation: NeuroRehabilitation, vol. 51, no. 4, pp. 681-691, 2022
Authors: Stampacchia, Giulia | Gazzotti, Valeria | Olivieri, Matteo | Andrenelli, Elisa | Bonaiuti, Donatella | Calabro, Rocco Salvatore | Carmignano, Simona Maria | Cassio, Anna | Fundaro, Cira | Companini, Isabella | Mazzoli, David | Cerulli, Simona | Chisari, Carmelo | Colombo, Valentina | Dalise, Stefania | Mazzoleni, Daniele | Melegari, Corrado | Merlo, Andrea | Boldrini, Paolo | Mazzoleni, Stefano | Posteraro, Federico | Mazzucchelli, Miriam | Benanti, Paolo | Castelli, Enrico | Draicchio, Francesco | Falabella, Vincenzo | Galeri, Silvia | Gimigliano, Francesca | Grigioni, Mauro | Mazzon, Stefano | Molteni, Franco | Morone, Giovanni | Petrarca, Maurizio | Picelli, Alessandro | Senatore, Michele | Turchetti, Giuseppe | Bizzarrini, Emiliana
Article Type: Review Article
Abstract: BACKGROUND: Many robots are available for gait rehabilitation (BWSTRT and ORET) and their application in persons with SCI allowed an improvement of walking function. OBJECTIVE: The aim of the study is to compare the effects of different robotic exoskeletons gait training in persons with different SCI level and severity. METHODS: Sixty-two studies were included in this systematic review; the study quality was assessed according to GRADE and PEDro’s scale. RESULTS: Quality assessment of included studies (n = 62) demonstrated a prevalence of evidence level 2; the quality of the studies was higher for BWSTRT (excellent and good) than for ORET (fair …and good). Almost all persons recruited for BWSTRT had an incomplete SCI; both complete and incomplete SCI were recruited for ORET. The SCI lesion level in the persons recruited for BWSTRT are from cervical to sacral; mainly from thoracic to sacral for ORET; a high representation of AIS D lesion resulted both for BWSTRT (30%) and for ORET (45%). The walking performance, tested with 10MWT, 6MWT, TUG and WISCI, improved after exoskeleton training in persons with incomplete SCI lesions, when at least 20 sessions were applied. Persons with complete SCI lesions improved the dexterity in walking with exoskeleton, but did not recover independent walking function; symptoms such as spasticity, pain and cardiovascular endurance improved. CONCLUSION: Different exoskeletons are available for walking rehabilitation in persons with SCI. The choice about the kind of robotic gait training should be addressed on the basis of the lesion severity and the possible comorbidities. Show more
Keywords: Gait rehabilitation, exoskeleton robot, spinal cord injury
DOI: 10.3233/NRE-220061
Citation: NeuroRehabilitation, vol. 51, no. 4, pp. 609-647, 2022
Authors: Carmignano, Simona Maria | Fundarò, Cira | Bonaiuti, Donatella | Calabrò, Rocco Salvatore | Cassio, Anna | Mazzoli, Davide | Bizzarini, Emiliana | Campanini, Isabella | Cerulli, Simona | Chisari, Carmelo | Colombo, Valentina | Dalise, Stefania | Gazzotti, Valeria | Mazzoleni, Daniele | Mazzucchelli, Miryam | Melegari, Corrado | Merlo, Andrea | Stampacchia, Giulia | Boldrini, Paolo | Mazzoleni, Stefano | Posteraro, Federico | Benanti, Paolo | Castelli, Enrico | Draicchio, Francesco | Falabella, Vincenzo | Galeri, Silvia | Gimigliano, Francesca | Grigioni, Mauro | Mazzon, Stefano | Molteni, Franco | Morone, Giovanni | Petrarca, Maurizio | Picelli, Alessandro | Senatore, Michele | Turchetti, Giuseppe | Andrenelli, Elisa
Article Type: Review Article
Abstract: BACKGROUND: Gait impairments are common disabling symptoms of Parkinson’s disease (PD). Among the approaches for gait rehabilitation, interest in robotic devices has grown in recent years. However, the effectiveness compared to other interventions, the optimum amount of training, the type of device, and which patients might benefit most remains unclear. OBJECTIVE: To conduct a systematic review about the effects on gait of robot-assisted gait training (RAGT) in PD patients and to provide advice for clinical practice. METHODS: A search was performed on PubMed, Scopus, PEDro, Cochrane library, Web of science, and guideline databases, following PRISMA guidelines. We included English articles …if they used a robotic system with details about the intervention, the parameters, and the outcome measures. We evaluated the level and quality of evidence. RESULTS: We included twenty papers out of 230 results: two systematic reviews, 9 randomized controlled trials, 4 uncontrolled studies, and 5 descriptive reports. Nine studies used an exoskeleton device and the remainders end-effector robots, with large variability in terms of subjects’ disease-related disability. CONCLUSIONS: RAGT showed benefits on gait and no adverse events were recorded. However, it does not seem superior to other interventions, except in patients with more severe symptoms and advanced disease. Show more
Keywords: Parkinson’s disease, rehabilitation, gait, medical device
DOI: 10.3233/NRE-220026
Citation: NeuroRehabilitation, vol. 51, no. 4, pp. 649-663, 2022
Authors: Castelli, Enrico | Beretta, Elena | De Tanti, Antonio | Arduini, Francesca | Biffi, Emilia | Colazza, Alessandra | Di Pede, Chiara | Guzzetta, Andrea | Lucarini, Ludovica | Maghini, Irene | Mandalà, Martina | Nespoli, Maurizio | Pavarelli, Claudia | Policastro, Francesca | Polverelli, Marco | Rossi, Andrea | Sgandurra, Giuseppina | Boldrini, Paolo | Bonaiuti, Donatella | Mazzoleni, Stefano | Posteraro, Federico | Benanti, Paolo | Draicchio, Francesco | Falabella, Vincenzo | Galeri, Silvia | Gimigliano, Francesca | Grigioni, Mauro | Mazzon, Stefano | Molteni, Franco | Morone, Giovanni | Petrarca, Maurizio | Picelli, Alessandro | Senatore, Michele | Turchetti, Giuseppe | Saviola, Donatella
Article Type: Review Article
Abstract: BACKGROUND: The use of robotic technologies in pediatric rehabilitation has seen a large increase, but with a lack of a comprehensive framework about their effectiveness. OBJECTIVE: An Italian Consensus Conference has been promoted to develop recommendations on these technologies: definitions and classification criteria of devices, indications and limits of their use in neurological diseases, theoretical models, ethical and legal implications. In this paper, we present the results for the pediatric age. METHODS: A systematic search on Cochrane Library, PEDro and PubMed was performed. Papers published up to March 1st, 2020, in English, were included and analyzed using the methodology of …the Centre for Evidence-Based Medicine in Oxford, AMSTAR2 and PEDro scales for systematic reviews and RCT, respectively. RESULTS: Some positives aspects emerged in the area of gait: an increased number of children reaching the stance, an improvement in walking distance, speed and endurance. Critical aspects include the heterogeneity of the studied cases, measurements and training protocols. CONCLUSION: Many studies demonstrate the benefits of robotic training in developmental age. However, it is necessary to increase the number of trials to achieve greater homogeneity between protocols and to confirm the effectiveness of pediatric robotic rehabilitation. Show more
Keywords: Robots, rehabilitation, gait, upper limb, lower limb, children
DOI: 10.3233/NRE-220036
Citation: NeuroRehabilitation, vol. 51, no. 4, pp. 665-679, 2022
Authors: Straudi, Sofia | Baluardo, Ludovica | Arienti, Chiara | Bozzolan, Michela | Lazzarini, Stefano G. | Agostini, Michela | Aprile, Irene | Paci, Matteo | Casanova, Emanuela | Marino, Dario | La Rosa, Giuseppe | Bressi, Federica | Sterzi, Silvia | Giansanti, Daniele | Perrero, Luca | Battistini, Alberto | Miccinilli, Sandra | Filoni, Serena | Sicari, Monica | Petrozzino, Salvatore | Solaro, Claudio Marcello | Gargano, Stefano | Benanti, Paolo | Boldrini, Paolo | Bonaiuti, Donatella | Castelli, Enrico | Draicchio, Francesco | Falabella, Vincenzo | Galeri, Silvia | Gimigliano, Francesca | Grigioni, Mauro | Mazzoleni, Stefano | Mazzon, Stefano | Molteni, Franco | Petrarca, Maurizio | Picelli, Alessandro | Posteraro, Federico | Senatore, Michele | Turchetti, Giuseppe | Morone, Giovanni
Article Type: Review Article
Abstract: BACKGROUND: Robot-assisted arm therapy (RAT) has been used mainly in stroke rehabilitation in the last 20 years with rising expectations and growing evidence summarized in systematic reviews (SRs). OBJECTIVE: The aim of this study is to provide an overview of SRs about the effectiveness, within the ICF domains, and safety of RAT in the rehabilitation of adult with stroke compared to other treatments. METHODS: The search strategy was conducted using search strings adapted explicitly for each database. A screening base on title and abstract was realized to find all the potentially relevant studies. The methodological quality of the included SRs …was assessed using AMSTAR-2. A pre-determined standardized form was used to realize the data extraction. RESULTS: 18 SRs were included in this overview. Generally, positive effects from the RAT were found for motor function and muscle strength, whereas there is no agreement for muscle tone effects. No effect was found for pain, and only a SR reported the positive impact of RAT in daily living activity. CONCLUSION: RAT can be considered a valuable option to increase motor function and muscle strength after stroke. However, the poor quality of most of the included SRs could limit the certainty around the results. Show more
Keywords: Stroke, arm rehabilitation, robot-assisted arm therapy, end-effector devices, exoskeleton devices
DOI: 10.3233/NRE-220027
Citation: NeuroRehabilitation, vol. 51, no. 4, pp. 559-576, 2022
Authors: Mazzucchelli, Miryam | Mazzoleni, Daniele | Campanini, Isabella | Merlo, Andrea | Mazzoli, Davide | Melegari, Corrado | Colombo, Valentina | Cerulli, Simona | Piscitelli, Daniele | Perin, Cecilia | Andrenelli, Elisa | Bizzarini, Emiliana | Calabro, Rocco Salvatore | Carmignano, Simona Maria | Cassio, Anna | Chisari, Carmelo | Dalise, Stefania | Fundaro, Cira | Gazzotti, Valeria | Stampacchia, Giulia | Boldrini, Paolo | Mazzoleni, Stefano | Posteraro, Federico | Benanti, Paolo | Castelli, Enrico | Draicchio, Francesco | Falabella, Vincenzo | Galeri, Silvia | Gimigliano, Francesca | Grigioni, Mauro | Mazzon, Stefano | Molteni, Franco | Morone, Giovanni | Petrarca, Maurizio | Picelli, Alessandro | Senatore, Michele | Turchetti, Giuseppe | Bonaiuti, Donatella
Article Type: Review Article
Abstract: BACKGROUND: The recovery of walking after stroke is a priority goal for recovering autonomy. In the last years robotic systems employed for Robotic Assisted Gait Training (RAGT) were developed. However, literature and clinical practice did not offer standardized RAGT protocol or pattern of evaluation scales. OBJECTIVE: This systematic review aimed to summarize the available evidence on the use of RAGT in post-stroke, following the CICERONE Consensus indications. METHODS: The literature search was conducted on PubMed, Cochrane Library and PEDro, including studies with the following criteria: 1) adult post-stroke survivors with gait disability in acute/subacute/chronic phase; 2) RAGT as intervention; 3) …any comparators; 4) outcome regarding impairment, activity, and participation; 5) both primary studies and reviews. RESULTS: Sixty-one articles were selected. Data about characteristics of patients, level of disability, robotic devices used, RAGT protocols, outcome measures, and level of evidence were extracted. CONCLUSION: It is possible to identify robotic devices that are more suitable for specific phase disease and level of disability, but we identified significant variability in dose and protocols. RAGT as an add-on treatment seemed to be prevalent. Further studies are needed to investigate the outcomes achieved as a function of RAGT doses delivered. Show more
Keywords: Stroke, gait, rehabilitation, robotics, lower extremity
DOI: 10.3233/NRE-220024
Citation: NeuroRehabilitation, vol. 51, no. 4, pp. 595-608, 2022
Authors: Bressi, Federica | Cricenti, Laura | Campagnola, Benedetta | Bravi, Marco | Miccinilli, Sandra | Santacaterina, Fabio | Sterzi, Silvia | Straudi, Sofia | Agostini, Michela | Paci, Matteo | Casanova, Emanuela | Marino, Dario | La Rosa, Giuseppe | Giansanti, Daniele | Perrero, Luca | Battistini, Alberto | Filoni, Serena | Sicari, Monica | Petrozzino, Salvatore | Solaro, Claudio Marcello | Gargano, Stefano | Benanti, Paolo | Boldrini, Paolo | Bonaiuti, Donatella | Castelli, Enrico | Draicchio, Francesco | Falabella, Vincenzo | Galeri, Silvia | Gimigliano, Francesca | Grigioni, Mauro | Mazzoleni, Stefano | Mazzon, Stefano | Molteni, Franco | Petrarca, Maurizio | Picelli, Alessandro | Posteraro, Federico | Senatore, Michele | Turchetti, Giuseppe | Morone, Giovanni | Gallotti, Marco | Germanotta, Marco | Aprile, Irene
Article Type: Review Article
Abstract: BACKGROUND: Robotic therapy (RT) has been internationally recognized for the motor rehabilitation of the upper limb. Although it seems that RT can stimulate and promote neuroplasticity, the effectiveness of robotics in restoring cognitive deficits has been considered only in a few recent studies. OBJECTIVE: To verify whether, in the current state of the literature, cognitive measures are used as inclusion or exclusion criteria and/or outcomes measures in robotic upper limb rehabilitation in stroke patients. METHODS: The systematic review was conducted according to PRISMA guidelines. Studies eligible were identified through PubMed/MEDLINE and Web of Science from inception to March 2021. RESULTS: …Eighty-one studies were considered in this systematic review. Seventy-three studies have at least a cognitive inclusion or exclusion criteria, while only seven studies assessed cognitive outcomes. CONCLUSION: Despite the high presence of cognitive instruments used for inclusion/exclusion criteria their heterogeneity did not allow the identification of a guideline for the evaluation of patients in different stroke stages. Therefore, although the heterogeneity and the low percentage of studies that included cognitive outcomes, seemed that the latter were positively influenced by RT in post-stroke rehabilitation. Future larger RCTs are needed to outline which cognitive scales are most suitable and their cut-off, as well as what cognitive outcome measures to use in the various stages of post-stroke rehabilitation. Show more
Keywords: Stroke, rehabilitation, cognitive outcome, robotic, upper limb, robotic rehabilitation, systematic review
DOI: 10.3233/NRE-220149
Citation: NeuroRehabilitation, vol. 51, no. 4, pp. 541-558, 2022
