Dissociating motor learning from recovery in exoskeleton training post-stroke.
Nicolas Schweighofer, Chunji Wang, Denis Mottet and 4 others
PMID 30290806WHAT IT FOUND
Movement smoothness during Armeo Spring training improved in a fast phase and a slow phase.
The early fast change was not a good marker of reduced impairment; only the slower change was associated with Fugl-Meyer score improvement. Initial exoskeleton scores are poor recovery markers.
Key findings
01In 53 people who received Armeo Spring training for four weeks, movement smoothness improved in a fast phase and a slow phase.
02The slow phase was correlated with change in UEFM (r = -0.64; p < 0.0001), but the fast phase was not (p = 0.33).
03Smoothness measured at test 1 was not correlated with pre-training UEFM (p = 0.10), so early exoskeleton scores were poor impairment markers.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The present analysis used a sub-cohort from the Armeo Spring arm of a larger trial, not the trial comparison itself, so it cannot show that training caused recovery. The authors state the work could not assess long-term benefit or a causal effect of motor training on recovery. Adherence varied: participants performed an average of 74 ± 13 tests, with a range of 33 to 86, and 36% performed 80 tests or more. Therapists adjusted test difficulty, so the number and position of targets varied across and within participants. The stroke group had moderate impairment and a single middle cerebral artery stroke, so the findings may not apply to people with different stroke locations or more severe impairment. Some baseline data were missing for gender, UEFM and days since stroke.
Declared interests
Funding came from the National Institute of Child Health and Human Development and the French ministry of health. The paper does not give an author conflict-of-interest declaration. The Armeo Spring device, software, games and tests were developed by Hocoma.
The easy way to misread this
Do not conclude that Armeo Spring training caused recovery. The study found that slow smoothness change was associated with Fugl-Meyer change, but it did not compare treated patients with an untreated control group and the authors say the analyses cannot show a causal effect of training.