Technologies et robotiques
Le 01/12/2022 de 09:00 à 10:30
Rééducation robotisée du membre supérieur parétique post-AVC. Partie 1 : changements de sévérité motrice et impact des modalités de rééducation après 5 semaines de traitement
Ophélie Pila (Boisisse Le Roi, France), Pascal Jamin (Valenton, France), Petra Breuckmann (Boisisse Le Roi, France), Anne-Gaëlle Grosmaire (Boisisse Le Roi, France), Christophe Duret (Boisisse Le Roi, France)
Objective : Robotic therapy (RT) integrated into upper limb (UL) post-stroke rehabilitation programs decreases motor deficits but functional outcomes remain uncertain. The objectives were to evaluate the effects on motor impairments of a 5-week UL training combining RT with conventional therapy in subacute phase and to define how patients who shifted from impairments category differed from those who did not.
Material / Patients and Methods : Clinically significant change was assessed by considering motor severity-based categories shift assessed by the Fugl-Meyer (FM) scale before and after therapy: severe (0<FM score≤19 pts), moderate (20≤FM score≤47 pts), and mild (FM score≥48 pts). In RT, proportion of patients was explored considering training modality used (assisted/active/resisted) between patients who shifted (G1, n=15) and those who did not (G2, n=16).
Results : At baseline (58(SD 26) days post-stroke), patients (n=31) had a mean FM score of 18(13)pts, increasing to 30(17)pts 40 days post-training initiation (p<0.001). Proportion of patients per impairments category changed between baseline and post-onset (p<0.05): it decreased from 74% to 35% in severe, increased from 26% to 52% in moderate and increased from 0% to 13% in mild. Proportion of patients by robotic training modality differed between-groups (p<0.001): in G1, the assisted modality was used on average by 72% of patients (vs 95% for G2), the active modality by 64% (vs 46% for G2) and the resisted modality by 34% (vs 14% for G2).
Discussion - Conclusion : This study indicated that a 5-week UL intensive combined training was associated with significant motor severity based-category shift from severe to moderate especially while active unassisted training was administered.
Keywords : hemiparesis, robot, subacute, upper extremity, severity, training modalities