Title : Robotics and mirror-therapy–based neurorehabilitation for stroke patients
Abstract:
Aims: Upper limb paresis, which includes disorders of extension and wrist control, is one of the most common and debilitating complications after a stroke. It significantly impacts patients' independence. Conventional rehabilitation methods do not always effectively improve this function long term, which justifies searching for new therapeutic solutions. In response to this need, a device with a soft balloon actuator called the Balonikotron has been developed to assist with wrist extension exercises using a balloon mechanism and audiovisual feedback. This pilot study aimed to evaluate the impact of a four-week therapy program using the Balonikotron on motor function, functional independence, and muscle tone in patients with upper limb paralysis after a stroke.
Material and Methods: A pilot study involving 12 stroke patients with upper limb paresis was conducted. The patients were randomized in a 1:1 ratio to the study group (n = 6) or the control group (n = 6). Hospitalization lasted four weeks and included a comprehensive neurological rehabilitation program. Both groups underwent a four-week therapeutic program aimed at restoring hand function as part of standard rehabilitation. The study group also participated in therapy using an innovative device with a balloon mechanism and mirror therapy elements. Assessments were performed before and after the intervention using the following scales: The Fugl-Meyer Assessment for the Upper Limb (FMA-UE), the Modified Ashworth Scale (MAS), the Activities of Daily Living (ADL), Modified Rankin Scale (mRS), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MOCA), wrist Range of Motion (ROM), and Barthel Index (BI).
Results: After the intervention, significant improvements in upper limb motor function (as assessed by the FMA-UE, Cohen’s d = 1.18, p = 0.045) and independence (as assessed by the ADL and BI, p = 0.02, p = 0.009) were observed. The average improvement in the experimental group was 19.17 points for the BI, while the control group's average improvement was only 6.67 points. The descriptive analysis of the MAS scale revealed no increase in spasticity among the patients. In fact, a decrease in spasticity was noted in some patients compared to the initial measurement. The range of wrist extension improved by 14.5° in the experimental group, while it deteriorated by 5.17° in the control group. An upward trend was observed in both the MMSE and MoCA scales, but the differences between the groups did not reach statistical significance (p = 0.151 for the MMSE and p = 0.187 for the MoCA).
Conclusion: Including robots in the neurological rehabilitation program for stroke patients can significantly support the recovery process. Using additional therapies with specialized devices promotes improvement in upper limb function, including wrist extension, and increases functional independence. The Balonikotron device, which is based on the mirror therapy mechanism, is a valuable addition to the rehabilitation of patients with hand paresis following a stroke.
