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Adaptive robot training for the treatment of incoordination in Multiple Sclerosis.

Vergaro E, Squeri V, Brichetto G, Casadio M, Morasso P, Solaro C, Sanguineti V - J Neuroeng Rehabil (2010)

Bottom Line: However over sessions, subjects exhibited an average 24% decrease in their NHPT score.After training, movements became smoother, and their curvature decreased significantly over sessions.The results point to an improved coordination over sessions and suggest a potential benefit of a short-term, customized, and adaptive robot therapy for MS subjects.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Genoa, Department of Informatics, Systems and Telecommunications, Via Opera Pia 13, Genoa, Italy. elena.vergaro@unige.it

ABSTRACT

Background: Cerebellar symptoms are extremely disabling and are common in Multiple Sclerosis (MS) subjects. In this feasibility study, we developed and tested a robot therapy protocol, aimed at the rehabilitation of incoordination in MS subjects.

Methods: Eight subjects with clinically defined MS performed planar reaching movements while grasping the handle of a robotic manipulandum, which generated forces that either reduced (error-reducing, ER) or enhanced (error-enhancing, EE) the curvature of their movements, assessed at the beginning of each session. The protocol was designed to adapt to the individual subjects' impairments, as well as to improvements between sessions (if any). Each subject went through a total of eight training sessions. To compare the effect of the two variants of the training protocol (ER and EE), we used a cross-over design consisting of two blocks of sessions (four ER and four EE; 2 sessions/week), separated by a 2-weeks rest period. The order of application of ER and EE exercises was randomized across subjects. The primary outcome measure was the modification of the Nine Hole Peg Test (NHPT) score. Other clinical scales and movement kinematics were taken as secondary outcomes.

Results: Most subjects revealed a preserved ability to adapt to the robot-generated forces. No significant differences were observed in EE and ER training. However over sessions, subjects exhibited an average 24% decrease in their NHPT score. The other clinical scales showed small improvements for at least some of the subjects. After training, movements became smoother, and their curvature decreased significantly over sessions.

Conclusions: The results point to an improved coordination over sessions and suggest a potential benefit of a short-term, customized, and adaptive robot therapy for MS subjects.

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Related in: MedlinePlus

Desired trajectory construction. Maximum lateral deviation (Δ) from the nominal path calculated after the evaluation of the mean trajectory (grey). It is tripled (3Δ) and centered. The corresponding point became the via-point for minimum-jerk trajectory that enhance (black line) or reduce (black dotted line) subject's error.
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Figure 2: Desired trajectory construction. Maximum lateral deviation (Δ) from the nominal path calculated after the evaluation of the mean trajectory (grey). It is tripled (3Δ) and centered. The corresponding point became the via-point for minimum-jerk trajectory that enhance (black line) or reduce (black dotted line) subject's error.

Mentions: An iterative algorithm, similar to that proposed in [28], was used to estimate and store the time profile of the forces, to be generated by the robot during the subsequent Subject Training phase. The algorithm aims at determining the forces that shift a subject's trajectory toward a 'reference' trajectory, xD(t). The 'reference' trajectory, xD(t), was defined as a 'minimum jerk' trajectory passing through three points [37]: the center, the target and a third via-point; see Figure 2.


Adaptive robot training for the treatment of incoordination in Multiple Sclerosis.

Vergaro E, Squeri V, Brichetto G, Casadio M, Morasso P, Solaro C, Sanguineti V - J Neuroeng Rehabil (2010)

Desired trajectory construction. Maximum lateral deviation (Δ) from the nominal path calculated after the evaluation of the mean trajectory (grey). It is tripled (3Δ) and centered. The corresponding point became the via-point for minimum-jerk trajectory that enhance (black line) or reduce (black dotted line) subject's error.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2927907&req=5

Figure 2: Desired trajectory construction. Maximum lateral deviation (Δ) from the nominal path calculated after the evaluation of the mean trajectory (grey). It is tripled (3Δ) and centered. The corresponding point became the via-point for minimum-jerk trajectory that enhance (black line) or reduce (black dotted line) subject's error.
Mentions: An iterative algorithm, similar to that proposed in [28], was used to estimate and store the time profile of the forces, to be generated by the robot during the subsequent Subject Training phase. The algorithm aims at determining the forces that shift a subject's trajectory toward a 'reference' trajectory, xD(t). The 'reference' trajectory, xD(t), was defined as a 'minimum jerk' trajectory passing through three points [37]: the center, the target and a third via-point; see Figure 2.

Bottom Line: However over sessions, subjects exhibited an average 24% decrease in their NHPT score.After training, movements became smoother, and their curvature decreased significantly over sessions.The results point to an improved coordination over sessions and suggest a potential benefit of a short-term, customized, and adaptive robot therapy for MS subjects.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Genoa, Department of Informatics, Systems and Telecommunications, Via Opera Pia 13, Genoa, Italy. elena.vergaro@unige.it

ABSTRACT

Background: Cerebellar symptoms are extremely disabling and are common in Multiple Sclerosis (MS) subjects. In this feasibility study, we developed and tested a robot therapy protocol, aimed at the rehabilitation of incoordination in MS subjects.

Methods: Eight subjects with clinically defined MS performed planar reaching movements while grasping the handle of a robotic manipulandum, which generated forces that either reduced (error-reducing, ER) or enhanced (error-enhancing, EE) the curvature of their movements, assessed at the beginning of each session. The protocol was designed to adapt to the individual subjects' impairments, as well as to improvements between sessions (if any). Each subject went through a total of eight training sessions. To compare the effect of the two variants of the training protocol (ER and EE), we used a cross-over design consisting of two blocks of sessions (four ER and four EE; 2 sessions/week), separated by a 2-weeks rest period. The order of application of ER and EE exercises was randomized across subjects. The primary outcome measure was the modification of the Nine Hole Peg Test (NHPT) score. Other clinical scales and movement kinematics were taken as secondary outcomes.

Results: Most subjects revealed a preserved ability to adapt to the robot-generated forces. No significant differences were observed in EE and ER training. However over sessions, subjects exhibited an average 24% decrease in their NHPT score. The other clinical scales showed small improvements for at least some of the subjects. After training, movements became smoother, and their curvature decreased significantly over sessions.

Conclusions: The results point to an improved coordination over sessions and suggest a potential benefit of a short-term, customized, and adaptive robot therapy for MS subjects.

Show MeSH
Related in: MedlinePlus