ORIGINAL ARTICLE   Free

European Journal of Physical and Rehabilitation Medicine 2020 August;56(4):444-50

DOI: 10.23736/S1973-9087.20.06112-2

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Robot-assisted arm training for treating adult patients with distal radius fracture: a proof-of-concept pilot study

Alessandro PICELLI ^{1, 2} ✉, Daniele MUNARI ², Angela MODENESE ², Mirko FILIPPETTI ¹, Gabriele SAGGIORO ², Marialuisa GANDOLFI ^{1, 2}, Massimo CORAIN ³, Nicola SMANIA ^{1, 2}

¹ Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; ² Unit of Neurorehabilitation, Department of Neurosciences, University Hospital of Verona, Verona, Italy; ³ Unit of Hand Surgery, Department of Surgery and Odontology, University Hospital of Verona, Verona, Italy

BACKGROUND: Fracture of the distal radius is a common wrist injury. As to its management after orthopedic (conservative or surgical) treatment, there is weak evidence for conventional rehabilitation interventions. Despite the increasing interest for robot-assisted arm therapy as to neurological disabilities and its growing diffusion in rehabilitation facilities, no previous study investigated the feasibility of robotic training on arm orthopedic impairment.
AIM: To evaluate the feasibility in terms of efficacy of robot-assisted arm training on upper limb impairment in patients with fracture of the distal radius.
DESIGN: Proof-of-concept, pilot, randomized controlled trial.
SETTING: University hospital.
POPULATION: Twenty adult outpatients with distal radius fracture due to wrist injury.
METHODS: All participants underwent ten, 1-hour (40 minutes of arm training + 20 minutes of conventional occupational therapy) training sessions, five days a week for two consecutive weeks. They were randomly assigned to two groups: patients allocated to the Robotic Arm Training group received arm training by means of a robotic device and patients allocated to the Conventional Arm Training group performed arm training following a conventional rehabilitation program. All patients were evaluated before, immediately after treatment and at four weeks of follow-up. The following outcomes were considered at the affected arm: forearm pronation/supination and wrist extension/flexion passive and active range of motion; maximal pinch and grip strength; the Patient-Rated Wrist and Hand Evaluation.
RESULTS: No difference was found between groups as to the primary (wrist active and passive range of motion) and secondary (pinch and grip strength; Patient-Rated Wrist and Hand Evaluation Score) outcomes at all time points. Within-group comparisons showed similar improvements at all time points as to all outcomes considered in both groups.
CONCLUSIONS: Our preliminary findings support the hypothesis that robot-assisted arm training might be a feasible tool for treating upper limb impairment in adult patients with distal radius fracture treated conservatively or surgically.
CLINICAL REHABILITATION IMPACT: The treatment of arm impairment consequent to distal radius fractures by means of robot-assisted arm training may allow therapists to focus on functional rehabilitation during occupational (individual) therapy and supervise (more than one) patients simultaneously during robotic training sessions.

KEY WORDS: Fractures, bone; Rehabilitation; Robotics; Wrist injuries