Title PROCJENA UČINKOVITOSTI ROBOTIKE U NEUROREHABILITACIJI GORNJIH EKSTREMITETA KOD PACIJENATA NAKON MOŽDANOG UDARA Title (english) EVALUATION OF THE EFFECTIVENESS OF ROBOTICS IN NEUROREHABILITATION OF THE UPPER EXTREMITIES IN PATIENTS AFTER STROKE Author Tomislav Barišić Mentor Tea Schnurrer-Luke-Vrbanić (mentor)Mentor Ivanka Baniček (komentor) Committee member Viviana Avancini-Dobrović (predsjednik povjerenstva)Committee member Vladimira Vuletić (član povjerenstva)Granter University of Rijeka Defense date and country 2021-09-28, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Moždani udar predstavlja nagli prekid moždanih funkcija uzrokovanih poremećajem
cirkulacije. Drugi je uzrok smrti, a vodeći uzrok invaliditeta u Europi i svijetu. Osobe koje su
preboljele moždani udar suočavaju se s deficitima koji ih ograničavaju u obavljanju prijašnjih
aktivnosti, pa neurorehabilitacija igra ključnu ulogu u procesu oporavka. Neuroplastičnost
predstavlja temelj na kojem se bazira suvremena neurorehabilitacija nakon oštećenja mozga. S
neurorehabilitacijskim procesom treba započeti odmah po stabilizaciji stanja pacijenta jer se
tada očekuje najbolji oporavak funkcija. Funkcije koje pacijent ne koristi, trajno se izgube, a za
uspješno provođenje terapije bitna je motivacija. Danas, uz tradicionalni terapijski pristup,
robotika je postala dostupnija i sve više se primjenjuje u neurorehabilitaciji. Robotski uređaji
mogu povećati motivaciju te pružiti veću dozu pacijentovog angažmana tijekom vježbanja, što
je možda teško postići tradicionalnim terapijskim pristupom. U ovom istraživanju koristili smo
egzoskeletni robotski uređaja Armeo Power. Cilj nam je bio analizirati utjecaj navedenog
robota na rehabilitaciju ruke u subakutnoj fazi kod osoba s jednostranim motoričkim ispadom
nakon moždanog udara.
Pacijenti uključeni u istraživanje bili su nasumično podijeljeni u eksperimentalnu
(n=10) i kontrolnu skupinu (n=10). Eksperimentalna skupina je uz konvencionalnu terapiju (5x
tjedno/4 tjedna; 45 min) provodila i terapiju na robotskom uređaju Armeo Power (5x tjedno/4
tjedna; 45 min) dok je kontrolna skupina provodila samo konvencionalnu terapiju. Terapije su
u obje skupine bile vremenski usklađene, a procjena se vršila putem kliničkih skala (FMA, FIM,
COPM). Kod svih kliničkih parametara u ponovljenim mjerenjima zabilježeno je statistički
značajno poboljšanje u obje promatrane skupine (p=0,005), osim kod procjene senzorne
funkcije gdje je eksperimentalna skupina zabilježila značajnije poboljšanje (p=0,018) dok u
kontrolnoj skupini do istog nije došlo (p=0,180). Usporedbom između skupina na kraju
liječenja nije utvrđena statistički značajna razlika u mjerama motoričke funkcije na FMA skali
(p=0,120) niti funkcionalne neovisnosti na FIM skali (p=0,762). Međutim, zbog statistički
značajne razlike između skupina na početku, teško je s velikim značajem promatrati usporedbu
na kraju liječenja, barem kada je riječ o FMA. Statistički značajna razlika između skupina na
kraju liječenja zabilježena je samo u rezultatima COPM-a (prosječno izvođenje, p=0,014;
prosječno zadovoljstvo, p=0,022). Dobiveni rezultati ukazuju da terapija robotskim uređajem
Armeo Power sigurno i učinkovito poboljšava funkcionalni oporavak nakon moždanog udara,
ali da nije superiornija u usporedbi s konvencionalnom terapijom.
Abstract (english) Stroke is a paroxysmal interruption of brain functions caused by the cerebral circulation
disorder. It is the second leading cause of death and the leading cause of disability in Europe
and the rest of the world. Stroke survivors struggle with many deficits, which restricts them in
performing previous activities on the same way. Because of that neurorehabilitation plays a
crucial role in the recovery process. Neuroplasticity constitute the basis of contemporary
neurorehabilitation after brain damage. Neurorehabilitation process should begin soon after the
stabilization of the patient's condition, because this period represents great odds for functional
recovery. Functions which patient doesn't use are permanently lost, and for successful therapy
patient motivation is extremely important. Today, with traditional therapeutic approach, robotic
therapy has become more accessible and is increasingly applied in neurorehabilitation. Robotic
devices can increase motivation and provide a higher engagement during exercise, which may
be difficult to achieve with a traditional therapeutic approach. In this study, we used the Armeo
Power (exoskeleton) robotic device. Our aim was to analyze the impact of this robot on the arm
rehabilitation in patients with unilateral motor deficit.
Patients with subacute stroke were randomly divided into experimental (n=10) and
control group (n=10). Experimental group performed therapy on the Armeo Power robotic
device (5x weekly/4 weeks; 45 min) in addition to conventional therapy (5x weekly/4 weeks;
45 min) while the control group performed only conventional therapy. Therapies were timealigned
in both groups, and assessment was performed using clinical scales (FMA, FIM,
COPM). In all clinical assessments the repeated measurements shown significant improvement
in both observed groups (p=0,005), except for the assessment of sensory function where the
experimental group recorded a significant improvement (p=0,018) but control group didn't (p
=0,180). Comparison between groups at the end of treatment didn't reveal significant difference
in measures of motor function on the FMA scale (p=0,120) or functional independence on the
FIM scale (p=0,762). However, due to significant difference between groups at baseline, it is
difficult to observe a comparison at the end of treatment with great importance, at least when it
comes to FMA. Significant difference between groups at the end of treatment was observed
only in COPM results (performance, p=0,014; satisfaction, p=0,022). The obtained results
indicate that the therapy with Armeo Power safely and effectively improves functional recovery
after stroke, but that it is not superior in comparison to conventional therapy.
Keywords
moždani udar
neurorehabilitacija
neuroplastičnost
robotika
Armeo Power
Keywords (english)
stroke
neurorehabilitation
neuroplasticity
robotics
Armeo Power
Language croatian URN:NBN urn:nbn:hr:184:527909 Study programme Title: Graduate university study of Physiotherapy (Biomedicine and Healthcare; clinical medical sciences) Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2022-05-02 11:44:14
