Neural Regeneration Research ›› 2021, Vol. 16 ›› Issue (8): 1566-1573.doi: 10.4103/1673-5374.301030

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Bimanual motor skill learning and robotic assistance for chronic hemiparetic stroke: a randomized controlled trial

Maral Yeganeh Doost1, 2, 3, Benoît Herman3, 4, Adrien Denis4, Julien Sapin5, Daniel Galinski5, Audrey Riga1, 2, 3, Patrice Laloux1, 2, Benoît Bihin6, Yves Vandermeeren1, 2, 3, *   

  1. 1UCLouvain, CHU UCL Namur – site Mont-Godinne, Department of Neurology, Stroke Unit, Yvoir, Belgium; 2UCLouvain, Institute of NeuroScience (IoNS), Clinical neuroscience division (NEUR) division, Brussels, Belgium; 3UCLouvain, Louvain Bionics, Louvain-la-Neuve, Belgium; 4UCLouvain, Institute of Mechanics, Materials and Civil Engineering (iMMC), Louvain-la-Neuve, Belgium; 5AXINESIS SA, Wavre, Belgique; 6Scientific Support Unit, CHU UCL Namur – site Mont-Godinne, Yvoir, Belgium
  • Online:2021-08-15 Published:2021-01-13
  • Contact: Yves Vandermeeren, MD, PhD, yves.vandermeeren@uclouvain.be.
  • Supported by:
    The work of YV was supported by the following grants: Fonds de la Recherche Scientifique – FNRS 1.R.506.16, 1.R.506.18 & 1.R.506.20, Fonds de la Recherche Scientifique Médicale (FRSM) 3.4.525.08.F, Fonds Spécial de Recherche (FSR) from the UCLouvain, Fondation Van Goethem-Brichant, and Fondation Mont-Godinne. The work of MYD was supported by the following grants: FRNS-FRIA n° F3/5/5-MCF/ROI/BC-19727 and F3/5/5-MCF/XH/FC-17514, and Fondation Mont-Godinne 2018. The work of AR was supported by grants from the Fondation Mont-Godinne 2015-2016, Fonds Spécial de Recherche (FSR) of the UCLouvain 2016-2018, and Fondation Roi Baudouin/Fonds Amélie 2018-2019.

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Abstract: Using robotic devices might improve recovery post-stroke, but the optimal way to apply robotic assistance has yet to be determined. The current study aimed to investigate whether training under the robotic active-assisted mode improves bimanual motor skill learning (biMSkL) more than training under the active mode in stroke patients. Twenty-six healthy individuals (HI) and 23 chronic hemiparetic stroke patients with a detectable lesion on MRI or CT scan, who demonstrated motor deficits in the upper limb, were randomly allocated to two parallel groups. The protocol included a two-day training on a new bimanual cooperative task, LIFT-THE-TRAY, under either the active or active-assisted modes (where assistance decreased in a pre-determined stepwise fashion) with the bimanual version of the REAplan® robotic device. The hypothesis was that the active-assisted mode would result in greater biMSkL than the active mode. The biMSkL was quantified by a speed-accuracy trade-off (SAT) before (T1) and immediately after (T2) training on days 1 and 2 (T3 and T4). The change in SAT after 2 days of training (T4/T1) indicated that both HI and stroke patients learned and retained the bimanual cooperative task. After 2 days of training, the active-assisted mode did not improve biMSkL more than the active mode (T4/T1) in HI nor stroke patients. Whereas HI generalized the learned bimanual skill to different execution speeds in both the active and active-assisted subgroups, the stroke patients generalized the learned skill only in the active subgroup. Taken together, the active-assisted mode, applied in a pre-determined stepwise decreasing fashion, did not improve biMSkL more than the active mode in HI and stroke subjects. Stroke subjects might benefit more from robotic assistance when applied “as-needed.” This study was approved by the local ethical committee (Comité d’éthique médicale, CHU UCL Namur, Mont-Godinne, Yvoir, Belgium; Internal number: 54/2010, EudraCT number: NUB B039201317382) on July 14, 2016 and was registered with ClinicalTrials.gov (Identifier: NCT03974750) on June 5, 2019. 

Key words: bimanual, hemiparesis, motor learning, rehabilitation, robotic, robotic assistance, slacking, stroke retention