A new treatment in the rehabilitation of the paretic upper limb after stroke: the ARAMIS prototype and treatment protocol

Abstract

Background: In recent years, as part of the rehabilitation of post stroke patients had widespread use of robotic technologies to improve recovery of upper limb. ARAMIS is a concept robot and prototype designed to promote the arms functional interaction in the neurorehabilitation of the paretic upper limb. Two computer-controlled, symmetric and interacting exoskeletons compensate for the inadequate strength and accuracy of the paretic arm and the effect of gravity during rehabilitation. Rehabilitation is possible in 3 different modalities; asynchronous, synchronous, active-assisted.

Objectives: to compare the effectiveness of rehabilitation robotic delivered through a exoskeleton prototype system compared to traditional rehabilitation in motor and functional recovery of the upper limb after stroke.

Methods: case-control study, 52 patients enrolled in the study, 28 cases (female: 8, age: 65 ± 10 yrs.) treated with ARAMIS (Automatic Recovery Arm Motility Integrated System) and 24 controls (female: 11, age: 69 ± 7 yrs.) with conventional rehabilitation.

Motor impairment assessed before and after treatment with Fugl-Meyer scale and Motricity Index, level of disability assessed with the Functional Independence Measure. A questionnaire also assessed the tolerability to therapy robotic.

Results: After 28±4 sessions over a 54±3.6 days period, patients treated by ARAMIS improved at the Fugl-Meyer scale (global score from 43±18 to 73±29 [p<0.00001]), Motricity Index scale (p<0.004) and Functional Independence Measure (p<0.001). A lesser degree of improvement was achieved at the conventional rehabilitation, The Fugl-Meyer global score of the control group improved from 41±13 to 58±16 (P<0.006) and the motor function item from 9.4±4.1 to 14.9±5.8 (p<0.023).

Conclusions: The motor improvement at wrist and hand proved greater than at shoulder and elbow in both patients treated by ARAMIS and controls, but it was significantly greater in ARAMIS-treated patients than in controls. The results indicate a greater efficacy of ARAMIS compared to conventional rehabilitation.