Adaptive robot training for the treatment of incoordination in Multiple Sclerosis

Journal of NeuroEngineering and Rehabilitation 2010, 7:37doi:10.1186/1743-0003-7-37

Elena Vergaro, Valentina Squeri, Giampaolo Brichetto, Maura Casadio, Pietro Morasso, Claudio Solaro and Vittorio Sanguineti.

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Abstract

Background
Cerebellar symptoms are extremely disabling and are common in Multiple Sclerosis (MS) patients. In this feasibility study, we developed and tested a robot therapy protocol, aimed at the rehabilitation of incoordination in MS subjects.

Methods
Eight subjects with clinically defined MS performed planar reaching movements while grasping the handle of a robotic manipulandum, which generated forces that either reduced (error-reducing, ER) or enhanced (error-enhancing, EE) the curvature of their movements, assessed at the beginning of each session. The protocol was designed to adapt to the individual subjects' impairments, as well as to improvements between sessions (if any). Each subject went through a total of eight training sessions. To compare the effect of the two variants of the training protocol (ER and EE), we used a cross-over design consisting into two blocks of sessions (four ER and four EE; 2 sessions/week), separated by a 2-week wash-out period. The order of application of ER and EE exercises was randomized across subjects. The primary outcome measure was the modification of the Nine Hole Peg Test (NHPT) score. Other clinical scales and movement kinematics were taken as secondary outcomes.

Results
Most subjects revealed a preserved ability to adapt to the robot-generated forces. No significant differences were observed in EE and ER training. However over sessions, subjects exhibited an average 24 % decrease in their NHPT score. The other clinical scales showed small improvements for at least some of the subjects. After training, movements became smoother, and their curvature decreased significantly over sessions.

Conclusions
The results point to an improved coordination over sessions, and suggest a potential benefit of a short-term, customized, and adaptive robot therapy for MS subjects.

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