Robot-assisted arm training in patients with Parkinson’s disease: a pilot study

BACKGROUND: Despite the growing diffusion of robotic devices in neurorehabilitation, no previous study investigated the effects of robotic training on arm impairment due to Parkinson’s disease. The aim of this pilot study was to evaluate whether robot-assisted arm training might improve upper limb function in patients with Parkinson’s disease. FINDINGS: Ten patients with Parkinson’s disease (Hoehn and Yahr stage 2.5-3) received ten, 45-minute, treatment sessions, five days a week, for two consecutive weeks. Robot-assisted arm training was performed with the Bi-Manu-Track (Reha-Stim, Berlin, Germany) that provides a computer-controlled, repetitive, bilateral, mirror-like practice of forearm pronation/supination and wrist extension/flexion. Patients were trained according to the following modalities: passive-passive (both arms moved by the machine) and active-active (both arms actively moving against resistance). The dominant upper limb was evaluated before and immediately after treatment as well as at two weeks of follow-up. Outcomes were the nine-hole peg test, the Fugl-Meyer assessment (upper limb section) and the Unified Parkinson’s Disease Rating Scale. After treatment, a significant improvement was found in the nine-hole peg test (P = 0.007) as well as in the upper limb section of the Fugl-Meyer assessment (P = 0.012). Findings were confirmed at the 2-week follow-up evaluation only for the nine-hole peg test (P = 0.007). No significant improvement was found in the Unified Parkinson’s Disease Rating Scale at both post-treatment and follow-up evaluations. CONCLUSIONS: Our findings support the hypothesis that robot-assisted arm training might be a promising tool in order to improve upper limb function in patients with Parkinson’s disease.