Robotic Kinematic measures of the arm in chronic Stroke: part 1 - Motor Recovery patterns from tDCS preceding intensive training

Caio B Moretti; Dylan J Edwards; Taya Hamilton; Mar Cortes; Avrielle Rykman Peltz; Johanna L Chang; Alexandre C B Delbem; Bruce T Volpe; Hermano I Krebs

doi:10.1186/s42234-021-00081-9

Robotic Kinematic measures of the arm in chronic Stroke: part 1 - Motor Recovery patterns from tDCS preceding intensive training

Bioelectron Med. 2021 Dec 29;7(1):20. doi: 10.1186/s42234-021-00081-9.

Authors

Caio B Moretti^{1

2}, Dylan J Edwards³, Taya Hamilton¹, Mar Cortes⁴, Avrielle Rykman Peltz⁵, Johanna L Chang⁶, Alexandre C B Delbem², Bruce T Volpe⁶, Hermano I Krebs⁷

Affiliations

¹ Department of Mechanical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, office 3-137, Cambridge, MA, 02139, USA.
² Universidade de Sao Paulo, Avenida Trabalhador Saocarlense - 400, Sao Carlos, SP, Brazil.
³ Moss Rehabilitation Research Institute, 60 Township Line Rd, Elkins Park, PA, 19027, USA.
⁴ Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA.
⁵ Rehabologym, 90 N Broadway, Irvington, NY, 10533, USA.
⁶ Feinstein Institute for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA.
⁷ Department of Mechanical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, office 3-137, Cambridge, MA, 02139, USA. hikrebs@mit.edu.

Abstract

Background: Effectiveness of robotic therapy and transcranial direct current stimulation is conventionally assessed with clinical measures. Robotic metrics may be more objective and sensitive for measuring the efficacy of interventions on stroke survivor's motor recovery. This study investigated if robotic metrics detect a difference in outcomes, not seen in clinical measures, in a study of transcranial direct current stimulation (tDCS) preceding robotic therapy. Impact of impairment severity on intervention response was also analyzed to explore optimization of outcomes by targeting patient sub-groups.

Methods: This 2020 study analyzed data from a double-blind, sham-controlled, randomized multi-center trial conducted from 2012 to 2016, including a six-month follow-up. 82 volunteers with single chronic ischemic stroke and right hemiparesis received anodal tDCS or sham stimulation, prior to robotic therapy. Robotic therapy involved 1024 repetitions, alternating shoulder-elbow and wrist robots, for a total of 36 sessions. Shoulder-elbow and wrist kinematic and kinetic metrics were collected at admission, discharge, and follow-up.

Results: No difference was detected between the tDCS or sham stimulation groups in the analysis of robotic shoulder-elbow or wrist metrics. Significant improvements in all metrics were found for the combined group analysis. Novel wrist data showed smoothness significantly improved (P < ·001) while submovement number trended down, overlap increased, and interpeak interval decreased. Post-hoc analysis showed only patients with severe impairment demonstrated a significant difference in kinematics, greater for patients receiving sham stimulation.

Conclusions: Robotic data confirmed results of clinical measures, showing intensive robotic therapy is beneficial, but no additional gain from tDCS. Patients with severe impairment did not benefit from the combined intervention. Wrist submovement characteristics showed a delayed pattern of motor recovery compared to the shoulder-elbow, relevant to intensive intervention-related recovery of upper extremity function in chronic stroke.

Trial registration: http://www.clinicaltrials.gov . Actual study start date September 2012. First registered on 15 November 2012. Retrospectively registered. Unique identifiers: NCT01726673 and NCT03562663 .

Keywords: Kinematics; Outcome measures; Robotics; Stroke; tDCS.

Associated data

ClinicalTrials.gov/NCT03562663
ClinicalTrials.gov/NCT01726673

Abstract

Associated data

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