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Rehabilitation robotics of the upper limb after stroke. The REM_AVC trial
Oral abstracts / Annals of Physical and Rehabilitation Medicine 61S (2018) e1–e102
ISPR8-0489
Rehabilitation robotics of the upper limb after stroke. The REM AVC trial O. Rémy-Néris 1,∗ , B. Médée 1 , D. Bensmail 2 , W. Daveluy 3 , C. Benaim 4 , J. Froger 5 , I. Bonan 6 , P. Marque 7 , J. Luaute 8 , A.L. Ferrapie 9 , A. Yelnik 10 , A. Stefan 11 , J.C. Daviet 12 , E. Coudeyre 13 , J.M. Beis 14 , J. Kerdraon 15 , J.L. Isambert 16 , P. Dehail 17 1 University hospital of Brest, Physical and rehabilitation medicine, Brest, France 2 Assistance publique–Hôpitaux de Paris, Physical and rehabilitation medicine, Garches, France 3 University hospital of Lille, Physical and rehabilitation medicine, Lille, France 4 University hospital of Dijon, Physical and rehabilitation medicine, Dijon, France 5 University hospital of Nimes, Physical and rehabilitation medicine, Nîmes, France 6 University hospital of Rennes, Physical and rehabilitation medicine, Rennes, France 7 University hospital of Toulouse, Physical and rehabilitation medicine, Toulouse, France 8 Hospices civil de Lyon, Physical and rehabilitation medicine, Lyon, France 9 C3RF, Physical and rehabilitation medicine, Angers, France 10 Assistance publique–Hôpitaux de Paris, Physical and rehabilitation medicine, Paris, France 11 University hospital of Nantes, Physical and rehabilitation medicine, Nantes, France 12 University hospital of Limoges, Physical and rehabilitation medicine, Limoges, France 13 University hospital of Clermont-Ferrand, Physical and rehabilitation medicine, Clermont-Ferrand, France 14 University institute of rehabilitation of Nancy, Physical and rehabilitation medicine, Nancy, France 15 CMRF Kerpape, Physical and rehabilitation medicine, Ploemeur, France 16 Le Normandy, Physical and rehabilitation medicine, Granville, France 17 University hospital of Bordeaux, Physical and rehabilitation medicine, Bordeaux, France ∗ Corresponding author. E-mail address: [email protected] (O. Rémy-Néris) Introduction/Background Rehabilitation robotics has been proposed as an efficient strategy to improve upper extremity (UE) motor function after stroke especially at the subacute phase. Many trials with several robots have been performed but very few large multicenter RCTs at the subacute phase. Material and method A multicenter parallel group, two arm, single blind, phase III, superiority, randomized, controlled trial has been conducted in France in 22 rehabilitation centers equipped with an Armeo Spring robot. Two hundred and twenty subjects must be included. The main inclusion criteria were an UE Fugl Meyer (UEFM) score between 10 and 40 and an occurrence of the stroke between 3 and 12 weeks before inclusion. The main outcome measure was the UE FM 30 days. Each patient performed usual treatment (2 hours a day of motor rehabilitation) with 20 additional rehabilitation sessions (1 h each, 5 days a week, 4 weeks). Patients were randomized either to rehabilitation robotic sessions with the Armeo Spring device or to self-rehabilitation (stretching and self paced movements) in equal timed sessions. Secondary outcome measures were, pain, hypertonia, functional improvement (FIM and Action research arm test ARAT) and quality of life (EQ5D and stroke impact scale). Evaluation were performed at day 30, 3, 6 and 12 months after inclusion. Results Two hundred and eighteen subjects have been included and an attrition rate of 10% at 6 months and 20% at 12 months was observed. The gain in the main outcome criteria was not signifi-
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cantly different at day 30 nor any other secondary criteria except ARAT. Conclusion An additional time 1 h a day during 4 weeks of rehabilitation robotics to usual intensive rehabilitation seems not significantly influence the motor deficiency prognosis of the upper limb after stroke. It might influence functional outcome but this has to be explored in another design randomized control study. Keywords Robot; Stroke; Subacute Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.045 ISPR8-0366
The effect of the association between prism adaptation and auditory cues on virtual spatial navigation in patients with unilateral neglect M. Cogné 1,∗ , E. Guillaud 2 , L. Guillot 3 , E. Klinger 4 , S. Jacquin-Courtois 5 , J.R. Cazalets 6 , P.A. Joseph 1 1 University Hospital of Bordeaux, Physical and Rehabilitation Medicine and EA4136, Bordeaux, France 2 INCIA, UMR CNRS Bordeaux University, Bordeaux, France 3 Bordeaux University, EA4136, Bordeaux, France 4 ESIEA, Digital Interactions Health and Disability Lab, Laval, France 5 University Hospital of Lyon, Physical and Rehabilitation Medicine and Inserm UMR-S 864-Espace et Action, Lyon, France 6 University of Bordeaux, INCIA-UMR CNRS Bordeaux University, Bordeaux, France ∗ Corresponding author. E-mail address: [email protected] (M. Cogné) Introduction/Background Spatial neglect is frequent among righthemispheric stroke patients, and can concern the auditory modality. Some authors showed that a prism adaptation improved the auditory extinction during a dichotic listening task. However, this effect has not been studied yet during an ecological task. The aims of the study were to investigate whether right-hemispheric stroke patients with a contralesional visual and auditory neglect benefited from an auditory lateralized cueing during a navigation task in virtual condition and to determine if a prism adaptation could potentiate this improvement. Material and method We included 32 right-hemispheric stroke patients, 22 with a visual and auditory neglect and10 without neglect; and 12 healthy controls. They all performed three paths including six intersections, at first passively and then actively with a joystick in two randomized conditions: (1) with lateralized beeping sounds indicating the directions; (2) without any sounds. After a prism adaptation, a third condition with lateralized beeping sounds was followed. Results There was a significant difference between the 3 groups concerning the number of trajectory mistakes in the 3 conditions (P < 0.05). Nevertheless, patients with unilateral neglect improved significantly their navigation performance in the condition with auditory stimuli compared to the condition without auditory stimuli, and even more so after a prism adaptation (P < 0.05). Conclusion This study demonstrates the positive effect of auditory cues for spatial navigation in virtual condition on patients with visual and auditory neglect, and the potentiation of the help of auditory cues after a prism adaptation in this population. Keywords Neglect; Auditory cues; Prism adaptation Disclosure of interest The authors thank the SOFMER (Société franc¸aise de médecine physique et de réadaptation) for funding the project named “AudiPrism”. https://doi.org/10.1016/j.rehab.2018.05.046
ISPR8-0489
Rehabilitation robotics of the upper limb after stroke. The REM AVC trial O. Rémy-Néris 1,∗ , B. Médée 1 , D. Bensmail 2 , W. Daveluy 3 , C. Benaim 4 , J. Froger 5 , I. Bonan 6 , P. Marque 7 , J. Luaute 8 , A.L. Ferrapie 9 , A. Yelnik 10 , A. Stefan 11 , J.C. Daviet 12 , E. Coudeyre 13 , J.M. Beis 14 , J. Kerdraon 15 , J.L. Isambert 16 , P. Dehail 17 1 University hospital of Brest, Physical and rehabilitation medicine, Brest, France 2 Assistance publique–Hôpitaux de Paris, Physical and rehabilitation medicine, Garches, France 3 University hospital of Lille, Physical and rehabilitation medicine, Lille, France 4 University hospital of Dijon, Physical and rehabilitation medicine, Dijon, France 5 University hospital of Nimes, Physical and rehabilitation medicine, Nîmes, France 6 University hospital of Rennes, Physical and rehabilitation medicine, Rennes, France 7 University hospital of Toulouse, Physical and rehabilitation medicine, Toulouse, France 8 Hospices civil de Lyon, Physical and rehabilitation medicine, Lyon, France 9 C3RF, Physical and rehabilitation medicine, Angers, France 10 Assistance publique–Hôpitaux de Paris, Physical and rehabilitation medicine, Paris, France 11 University hospital of Nantes, Physical and rehabilitation medicine, Nantes, France 12 University hospital of Limoges, Physical and rehabilitation medicine, Limoges, France 13 University hospital of Clermont-Ferrand, Physical and rehabilitation medicine, Clermont-Ferrand, France 14 University institute of rehabilitation of Nancy, Physical and rehabilitation medicine, Nancy, France 15 CMRF Kerpape, Physical and rehabilitation medicine, Ploemeur, France 16 Le Normandy, Physical and rehabilitation medicine, Granville, France 17 University hospital of Bordeaux, Physical and rehabilitation medicine, Bordeaux, France ∗ Corresponding author. E-mail address: [email protected] (O. Rémy-Néris) Introduction/Background Rehabilitation robotics has been proposed as an efficient strategy to improve upper extremity (UE) motor function after stroke especially at the subacute phase. Many trials with several robots have been performed but very few large multicenter RCTs at the subacute phase. Material and method A multicenter parallel group, two arm, single blind, phase III, superiority, randomized, controlled trial has been conducted in France in 22 rehabilitation centers equipped with an Armeo Spring robot. Two hundred and twenty subjects must be included. The main inclusion criteria were an UE Fugl Meyer (UEFM) score between 10 and 40 and an occurrence of the stroke between 3 and 12 weeks before inclusion. The main outcome measure was the UE FM 30 days. Each patient performed usual treatment (2 hours a day of motor rehabilitation) with 20 additional rehabilitation sessions (1 h each, 5 days a week, 4 weeks). Patients were randomized either to rehabilitation robotic sessions with the Armeo Spring device or to self-rehabilitation (stretching and self paced movements) in equal timed sessions. Secondary outcome measures were, pain, hypertonia, functional improvement (FIM and Action research arm test ARAT) and quality of life (EQ5D and stroke impact scale). Evaluation were performed at day 30, 3, 6 and 12 months after inclusion. Results Two hundred and eighteen subjects have been included and an attrition rate of 10% at 6 months and 20% at 12 months was observed. The gain in the main outcome criteria was not signifi-
e21
cantly different at day 30 nor any other secondary criteria except ARAT. Conclusion An additional time 1 h a day during 4 weeks of rehabilitation robotics to usual intensive rehabilitation seems not significantly influence the motor deficiency prognosis of the upper limb after stroke. It might influence functional outcome but this has to be explored in another design randomized control study. Keywords Robot; Stroke; Subacute Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.045 ISPR8-0366
The effect of the association between prism adaptation and auditory cues on virtual spatial navigation in patients with unilateral neglect M. Cogné 1,∗ , E. Guillaud 2 , L. Guillot 3 , E. Klinger 4 , S. Jacquin-Courtois 5 , J.R. Cazalets 6 , P.A. Joseph 1 1 University Hospital of Bordeaux, Physical and Rehabilitation Medicine and EA4136, Bordeaux, France 2 INCIA, UMR CNRS Bordeaux University, Bordeaux, France 3 Bordeaux University, EA4136, Bordeaux, France 4 ESIEA, Digital Interactions Health and Disability Lab, Laval, France 5 University Hospital of Lyon, Physical and Rehabilitation Medicine and Inserm UMR-S 864-Espace et Action, Lyon, France 6 University of Bordeaux, INCIA-UMR CNRS Bordeaux University, Bordeaux, France ∗ Corresponding author. E-mail address: [email protected] (M. Cogné) Introduction/Background Spatial neglect is frequent among righthemispheric stroke patients, and can concern the auditory modality. Some authors showed that a prism adaptation improved the auditory extinction during a dichotic listening task. However, this effect has not been studied yet during an ecological task. The aims of the study were to investigate whether right-hemispheric stroke patients with a contralesional visual and auditory neglect benefited from an auditory lateralized cueing during a navigation task in virtual condition and to determine if a prism adaptation could potentiate this improvement. Material and method We included 32 right-hemispheric stroke patients, 22 with a visual and auditory neglect and10 without neglect; and 12 healthy controls. They all performed three paths including six intersections, at first passively and then actively with a joystick in two randomized conditions: (1) with lateralized beeping sounds indicating the directions; (2) without any sounds. After a prism adaptation, a third condition with lateralized beeping sounds was followed. Results There was a significant difference between the 3 groups concerning the number of trajectory mistakes in the 3 conditions (P < 0.05). Nevertheless, patients with unilateral neglect improved significantly their navigation performance in the condition with auditory stimuli compared to the condition without auditory stimuli, and even more so after a prism adaptation (P < 0.05). Conclusion This study demonstrates the positive effect of auditory cues for spatial navigation in virtual condition on patients with visual and auditory neglect, and the potentiation of the help of auditory cues after a prism adaptation in this population. Keywords Neglect; Auditory cues; Prism adaptation Disclosure of interest The authors thank the SOFMER (Société franc¸aise de médecine physique et de réadaptation) for funding the project named “AudiPrism”. https://doi.org/10.1016/j.rehab.2018.05.046