Robot-assisted therapy for upper limb paresis after stroke: Use of robotic algorithms in advanced practice.

BACKGROUND: Rehabilitation of stroke-related upper limb paresis is a major public health issue. OBJECTIVE: Robotic systems have been developed to facilitate neurorehabilitation by providing key elements required to stimulate brain plasticity and motor recovery, namely repetitive, intensive, adaptative training with feedback. Although the positive effect of robot-assisted therapy on motor impairments has been well demonstrated, the effect on functional capacity is less certain. METHOD: This narrative review outlines the principles of robot-assisted therapy for the rehabilitation of post-stroke upper limb paresis. RESULTS: A paradigm is proposed to promote not only recovery of impairment but also function. CONCLUSION: Further studies that would integrate some principles of the paradigm described in this paper are needed.

Adapted physical activity in community-dwelling adults with neurological disorders: design and outcomes of a fitness-center based program.

PURPOSE: To describe and evaluate an adapted physical activity-based program (APA-program) designed for community-dwelling patients with neurological diseases in local fitness centers. MATERIALS AND METHODS: The APA-program consisted of individual and group activities supervised by an adapted physical activity (APA) instructor twice a week for 6 months. Clinical evaluations before and after the APA-program included strength tests on gym machines, the six-minute walk test (6MWT), the single-leg stance test, and the Short Form-36 (SF-36). RESULTS: Between January 2017 and May 2019, 79 individuals participated in the APA-program (33 women, mean age 59 ± 14 years, 47 stroke, 13 multiple sclerosis, and 19 other neurological diseases). All physical outcomes improved significantly: upper body strength increased by 49%, lower body strength by 37%, 6MWT by 22%, single-leg stance time by 86%, and SF-36 Mental and Physical scores by 23%. Sixty-eight percent of participants completed the 6-month program and 83% of completers then purchased a one-year subscription in the fitness center. CONCLUSIONS: The 6-month APA-program improved participant's physical abilities and quality of life. More than half of participants decided to subscribe personally to the fitness center at the end of the program, supporting the development of community APA-programs for people with chronic neurological diseases, in collaboration with rehabilitation hospitals.Implications for rehabilitationA physical activity-based-program implemented in a fitness center is effective in improving physical fitness and quality of life in people suffering from neurological disorders such as stroke and multiple sclerosis.Close coordination between rehabilitation hospitals and local fitness centers, training by skilled adapted physical activity instructors and group activities are critical determinants of successful participation.