The impact of robot-mediated adaptive I-TRAVLE training on impaired upper limb function in chronic stroke and multiple sclerosis.

PURPOSE: The current study aimed to investigate proof-of-concept efficacy of an individualized, robot-mediated training regime for people with MS (pwMS) and stroke patients. METHOD: Thirteen pwMS and 14 chronic stroke patients performed 36 (stroke) or 40 (pwMS) training sessions with the I-TRAVLE system. Evaluation of upper limb function was performed at baseline, after training and at 3 months follow-up. Clinical outcome measures consisted of active range of motion (ROM), Motricity Index, Jamar handgrip strength, perceived fatigue and strength, Wolf Motor Function Test (WFMT) and ABILHAND. Robot-generated outcome measures consisted of movement velocity, ROM and actual covered distance compared to straight-line distance. RESULTS: In pwMS, significant improvements were found after training in active shoulder ROM, handgrip strength, perceived strength and WMFT activities. No significant change in clinical outcome was found in stroke patients, except for perceived strength. Significant improvement in speed and movement duration was found after training in both groups. At follow-up, clinical outcome deteriorated in pwMS and was maintained in stroke patients. CONCLUSIONS: Robot-mediated training resulted in improved movement coordination in both groups, as well as clinical improvement in pwMS. Absence of functional improvements in stroke patients may relate to severe upper limb dysfunction at baseline. Implications for Rehabilitation Robot-mediated training improved strength, active range of motion and upper limb capacity in pwMS. Robot-mediated therapy allows for adapted training difficulty.

Motor fatigability after low-intensity hand grip exercises in persons with multiple sclerosis.

INTRODUCTION: During maximal, sustained contractions, persons with multiple sclerosis (PwMS) show higher motor fatigability in comparison with healthy persons. It is not known if motor fatigability is also different between PwMS and healthy persons during low-intensity exercises. Thus, the aim of this study was to determine the difference in hand grip fatigability between healthy persons and PwMS for both hands during low-intensity hand grip exercises. METHODS: 19 PwMS and 19 healthy controls performed 18min of hand grip exercises at a maximum of 25% of the maximal voluntary strength, with an electronic hand dynamometer. Perceived fatigability, maximal hand grip strength and muscle activity (electromyography) of the wrist flexors and extensors were recorded in between these exercises for the dominant and non-dominant hand. RESULTS AND DISCUSSION: There was a significant decrease in maximal hand grip strength after exercising in both groups and for both hands, mainly situated in the first 6min. In contrast to what was hypothesized, PwMS did not show more decline in strength than healthy controls, neither in the dominant nor the non-dominant hand. There was no group difference in the increase of the perceived fatigability in the dominant hand. However, for the non-dominant hand, the perceived fatigability after exercising increased more in PwMS than in healthy controls. Additionally, there was no relation between fatigue indices, as assessed with short maximal contractions and the strength decline after low-intensity repetitive exercises.