Return to Work and Quality of Life after Stroke in Italy: A Study on the Efficacy of Technologically Assisted Neurorehabilitation

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Abstract

Cerebrovascular diseases, including stroke, are historically considered diseases of old adults so only in a few studies has “return to work” (RTW) been considered as an index of rehabilitative outcome. At the moment, data on RTW in patients with stroke are highly variable: four different reviews reported the following ranges: 11–85%, 19–73%, 22–53%, and 40–45%. The absence of re-integration to work after a stroke is shown to be associated with an increase of cardiac disorders and depression, with a higher level of mortality, with social isolation and with insufficient adaptive skills. The aim of this study was to verify the effectiveness of technological treatment, performed with optic (SonicHand) and wearable (Riablo™) systems providing auditory and visual biofeedback, on RTW in patients with stroke. RTW was found to be associated with a higher independence in the activities of daily living (assessed by the Modified Barthel Index). No significant differences were found between technological versus conventional rehabilitation in terms of RTW, despite the former showing a higher odds ratio than the latter (OR = 9 vs. 6). Assistive devices were mainly used in patients who had not returned to work. Finally, quality of life was found higher in those patients who returned to work with the same conditions (work duties and time) as before stroke.

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Rehabilitation robots for the treatment of sensorimotor deficits: a neurophysiological perspective

Roger Gassert, Volker Dietz (2018)

The past decades have seen rapid and vast developments of robots for the rehabilitation of sensorimotor deficits after damage to the central nervous system (CNS). Many of these innovations were technology-driven, limiting their clinical application and impact. Yet, rehabilitation robots should be designed on the basis of neurophysiological insights underlying normal and impaired sensorimotor functions, which requires interdisciplinary collaboration and background knowledge. Recovery of sensorimotor function after CNS damage is based on the exploitation of neuroplasticity, with a focus on the rehabilitation of movements needed for self-independence. This requires a physiological limb muscle activation that can be achieved through functional arm/hand and leg movement exercises and the activation of appropriate peripheral receptors. Such considerations have already led to the development of innovative rehabilitation robots with advanced interaction control schemes and the use of integrated sensors to continuously monitor and adapt the support to the actual state of patients, but many challenges remain. For a positive impact on outcome of function, rehabilitation approaches should be based on neurophysiological and clinical insights, keeping in mind that recovery of function is limited. Consequently, the design of rehabilitation robots requires a combination of specialized engineering and neurophysiological knowledge. When appropriately applied, robot-assisted therapy can provide a number of advantages over conventional approaches, including a standardized training environment, adaptable support and the ability to increase therapy intensity and dose, while reducing the physical burden on therapists. Rehabilitation robots are thus an ideal means to complement conventional therapy in the clinic, and bear great potential for continued therapy and assistance at home using simpler devices. This review summarizes the evolution of the field of rehabilitation robotics, as well as the current state of clinical evidence. It highlights fundamental neurophysiological factors influencing the recovery of sensorimotor function after a stroke or spinal cord injury, and discusses their implications for the development of effective rehabilitation robots. It thus provides insights on essential neurophysiological mechanisms to be considered for a successful development and clinical inclusion of robots in rehabilitation.

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Auckland Stroke Outcomes Study. Part 2: Cognition and functional outcomes 5 years poststroke.

Carlene M M Lawes, Charlotte Barker, H E Senior … (2010)

Understanding the extent of long-term neuropsychological deficits poststroke and their contribution to functional outcomes is essential for evidence-based rehabilitation and resource planning, and could improve stroke outcomes. However, most existing neuropsychological stroke data are not population-based, examine limited outcomes, and have short-term follow-up. This population-based long-term stroke follow-up study examined associations between neuropsychological deficits (memory, executive function, information processing speed [IPS], visuoperceptual/construction ability, language), depression, and a range of functional outcomes and their interrelationships 5 years poststroke. The greatest proportion of the 307 participants exhibited neuropsychological functioning within the average range, and about 30%-50% performed at lower levels on most measures; few performed above the average range. Deficits were most common in executive functioning and IPS, and 30.4% of participants were depressed. While correlation analyses indicate all cognitive domains are significantly related to functional outcomes, multiple regression analyses showed that only IPS and visuoperceptual ability made significant independent contributions to functional outcomes over and above age, depression, and current Barthel Index. Depression also made a significant and independent contribution to functional outcomes. A considerable proportion of 5-year stroke survivors experience neuropsychological deficits, with these being more likely to involve IPS and executive functioning. Visuoperceptual/construction abilities, visual memory, and IPS were independently associated with handicap, disability, and health-related quality of life over and above contributions made by age, depression, and stroke severity, suggesting these areas are important targets for rehabilitation to improve overall stroke recovery and should be evaluated in future randomized controlled trials.

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Robot-assisted gait training for stroke patients: current state of the art and perspectives of robotics

Giovanni Morone, Stefano Paolucci, Andrea Cherubini … (2017)

In this review, we give a brief outline of robot-mediated gait training for stroke patients, as an important emerging field in rehabilitation. Technological innovations are allowing rehabilitation to move toward more integrated processes, with improved efficiency and less long-term impairments. In particular, robot-mediated neurorehabilitation is a rapidly advancing field, which uses robotic systems to define new methods for treating neurological injuries, especially stroke. The use of robots in gait training can enhance rehabilitation, but it needs to be used according to well-defined neuroscientific principles. The field of robot-mediated neurorehabilitation brings challenges to both bioengineering and clinical practice. This article reviews the state of the art (including commercially available systems) and perspectives of robotics in poststroke rehabilitation for walking recovery. A critical revision, including the problems at stake regarding robotic clinical use, is also presented.

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Journal

Journal ID (nlm-ta): Int J Environ Res Public Health

Journal ID (iso-abbrev): Int J Environ Res Public Health

Journal ID (publisher-id): ijerph

Title: International Journal of Environmental Research and Public Health

Publisher: MDPI

ISSN (Print): 1661-7827

ISSN (Electronic): 1660-4601

Publication date (Electronic): 20 July 2020

Publication date (Print): July 2020

Volume: 17

Issue: 14

Electronic Location Identifier: 5233

Affiliations

[1 ]IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy; sheyda.ghanbarighoshchi@ 123456uniroma1.it (S.G.G.); s.deangelis@ 123456hsantalucia.it (S.D.A.); g.morone@ 123456hsantalucia.it (G.M.); m.tramontano@ 123456hsantalucia.it (M.T.); pierluigi.zoccolotti@ 123456uniroma1.it (P.Z.); s.paolucci@ 123456hsantalucia.it (S.P.)

[2 ]Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy

[3 ]Istituti Clinici Scientifici Maugeri IRCSS, Occupational Therapy and Ergonomics Unit, 27040 Montescano, Italy; monica.panigazzi@ 123456icsmaugeri.it

[4 ]Istituti Clinici Scientifici Maugeri IRCSS, Occupational Therapy and Ergonomics Unit, 27100 Pavia, Italy; edda.capodaglio@ 123456icsmaugeri.it

[5 ]Italian Workers’ Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Monte Porzio Catone, 00078 Rome, Italy; b.persechino@ 123456inail.it

[6 ]Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, 00135 Rome, Italy

Author notes

[* ]Correspondence: m.iosa@ 123456hsantalucia.it

[†]

These two authors contributed equally to this work.

Author information

Marco Tramontano https://orcid.org/0000-0001-6034-0638

Pierluigi Zoccolotti https://orcid.org/0000-0002-6351-2455

Article

Publisher ID: ijerph-17-05233

DOI: 10.3390/ijerph17145233

PMC ID: 7399919

PubMed ID: 32698430

SO-VID: 7ad6c27f-5505-4b52-aa03-f4931ab30bab

License:

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

Return to Work and Quality of Life after Stroke in Italy: A Study on the Efficacy of Technologically Assisted Neurorehabilitation

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Chinese Journal of School Health

Most cited references 39

Rehabilitation robots for the treatment of sensorimotor deficits: a neurophysiological perspective

Auckland Stroke Outcomes Study. Part 2: Cognition and functional outcomes 5 years poststroke.

Robot-assisted gait training for stroke patients: current state of the art and perspectives of robotics

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