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Combining Robotic Training and Non-Invasive Brain Stimulation in Severe Upper Limb-Impaired Chronic Stroke Patients

Previous studies suggested that both robot-assisted rehabilitation and non-invasive brain stimulation can produce a slight improvement in severe chronic stroke patients. It is still unknown whether their combination can produce synergistic and more consistent improvements. Safety and efficacy of thi...

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Autores principales: Di Lazzaro, Vincenzo, Capone, Fioravante, Di Pino, Giovanni, Pellegrino, Giovanni, Florio, Lucia, Zollo, Loredana, Simonetti, Davide, Ranieri, Federico, Brunelli, Nicoletta, Corbetto, Marzia, Miccinilli, Sandra, Bravi, Marco, Milighetti, Stefano, Guglielmelli, Eugenio, Sterzi, Silvia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4782015/
https://www.ncbi.nlm.nih.gov/pubmed/27013950
http://dx.doi.org/10.3389/fnins.2016.00088
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author Di Lazzaro, Vincenzo
Capone, Fioravante
Di Pino, Giovanni
Pellegrino, Giovanni
Florio, Lucia
Zollo, Loredana
Simonetti, Davide
Ranieri, Federico
Brunelli, Nicoletta
Corbetto, Marzia
Miccinilli, Sandra
Bravi, Marco
Milighetti, Stefano
Guglielmelli, Eugenio
Sterzi, Silvia
author_facet Di Lazzaro, Vincenzo
Capone, Fioravante
Di Pino, Giovanni
Pellegrino, Giovanni
Florio, Lucia
Zollo, Loredana
Simonetti, Davide
Ranieri, Federico
Brunelli, Nicoletta
Corbetto, Marzia
Miccinilli, Sandra
Bravi, Marco
Milighetti, Stefano
Guglielmelli, Eugenio
Sterzi, Silvia
author_sort Di Lazzaro, Vincenzo
collection PubMed
description Previous studies suggested that both robot-assisted rehabilitation and non-invasive brain stimulation can produce a slight improvement in severe chronic stroke patients. It is still unknown whether their combination can produce synergistic and more consistent improvements. Safety and efficacy of this combination has been assessed within a proof-of-principle, double-blinded, semi-randomized, sham-controlled trial. Inhibitory continuous Theta Burst Stimulation (cTBS) was delivered on the affected hemisphere, in order to improve the response to the following robot-assisted therapy via a homeostatic increase of learning capacity. Twenty severe upper limb-impaired chronic stroke patients were randomized to robot-assisted therapy associated with real or sham cTBS, delivered for 10 working days. Eight real and nine sham patients completed the study. Change in Fugl-Meyer was chosen as primary outcome, while changes in several quantitative indicators of motor performance extracted by the robot as secondary outcomes. The treatment was well-tolerated by the patients and there were no adverse events. All patients achieved a small, but significant, Fugl-Meyer improvement (about 5%). The difference between the real and the sham cTBS groups was not significant. Among several secondary end points, only the Success Rate (percentage of targets reached by the patient) improved more in the real than in the sham cTBS group. This study shows that a short intensive robot-assisted rehabilitation produces a slight improvement in severe upper-limb impaired, even years after the stroke. The association with homeostatic metaplasticity-promoting non-invasive brain stimulation does not augment the clinical gain in patients with severe stroke.
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spelling pubmed-47820152016-03-24 Combining Robotic Training and Non-Invasive Brain Stimulation in Severe Upper Limb-Impaired Chronic Stroke Patients Di Lazzaro, Vincenzo Capone, Fioravante Di Pino, Giovanni Pellegrino, Giovanni Florio, Lucia Zollo, Loredana Simonetti, Davide Ranieri, Federico Brunelli, Nicoletta Corbetto, Marzia Miccinilli, Sandra Bravi, Marco Milighetti, Stefano Guglielmelli, Eugenio Sterzi, Silvia Front Neurosci Psychiatry Previous studies suggested that both robot-assisted rehabilitation and non-invasive brain stimulation can produce a slight improvement in severe chronic stroke patients. It is still unknown whether their combination can produce synergistic and more consistent improvements. Safety and efficacy of this combination has been assessed within a proof-of-principle, double-blinded, semi-randomized, sham-controlled trial. Inhibitory continuous Theta Burst Stimulation (cTBS) was delivered on the affected hemisphere, in order to improve the response to the following robot-assisted therapy via a homeostatic increase of learning capacity. Twenty severe upper limb-impaired chronic stroke patients were randomized to robot-assisted therapy associated with real or sham cTBS, delivered for 10 working days. Eight real and nine sham patients completed the study. Change in Fugl-Meyer was chosen as primary outcome, while changes in several quantitative indicators of motor performance extracted by the robot as secondary outcomes. The treatment was well-tolerated by the patients and there were no adverse events. All patients achieved a small, but significant, Fugl-Meyer improvement (about 5%). The difference between the real and the sham cTBS groups was not significant. Among several secondary end points, only the Success Rate (percentage of targets reached by the patient) improved more in the real than in the sham cTBS group. This study shows that a short intensive robot-assisted rehabilitation produces a slight improvement in severe upper-limb impaired, even years after the stroke. The association with homeostatic metaplasticity-promoting non-invasive brain stimulation does not augment the clinical gain in patients with severe stroke. Frontiers Media S.A. 2016-03-08 /pmc/articles/PMC4782015/ /pubmed/27013950 http://dx.doi.org/10.3389/fnins.2016.00088 Text en Copyright © 2016 Di Lazzaro, Capone, Di Pino, Pellegrino, Florio, Zollo, Simonetti, Ranieri, Brunelli, Corbetto, Miccinilli, Bravi, Milighetti, Guglielmelli and Sterzi. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Psychiatry
Di Lazzaro, Vincenzo
Capone, Fioravante
Di Pino, Giovanni
Pellegrino, Giovanni
Florio, Lucia
Zollo, Loredana
Simonetti, Davide
Ranieri, Federico
Brunelli, Nicoletta
Corbetto, Marzia
Miccinilli, Sandra
Bravi, Marco
Milighetti, Stefano
Guglielmelli, Eugenio
Sterzi, Silvia
Combining Robotic Training and Non-Invasive Brain Stimulation in Severe Upper Limb-Impaired Chronic Stroke Patients
title Combining Robotic Training and Non-Invasive Brain Stimulation in Severe Upper Limb-Impaired Chronic Stroke Patients
title_full Combining Robotic Training and Non-Invasive Brain Stimulation in Severe Upper Limb-Impaired Chronic Stroke Patients
title_fullStr Combining Robotic Training and Non-Invasive Brain Stimulation in Severe Upper Limb-Impaired Chronic Stroke Patients
title_full_unstemmed Combining Robotic Training and Non-Invasive Brain Stimulation in Severe Upper Limb-Impaired Chronic Stroke Patients
title_short Combining Robotic Training and Non-Invasive Brain Stimulation in Severe Upper Limb-Impaired Chronic Stroke Patients
title_sort combining robotic training and non-invasive brain stimulation in severe upper limb-impaired chronic stroke patients
topic Psychiatry
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4782015/
https://www.ncbi.nlm.nih.gov/pubmed/27013950
http://dx.doi.org/10.3389/fnins.2016.00088
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