Abstract :
[en] Background: Patients with multiple sclerosis (MS) may suffer from balance and gait impairments, which affect their quality of life (Oh et al., 2018). New approaches such as robot-assisted rehabilitation show promising results in the management of MS but require further validation through more in-depth research, including larger-scale studies (Zasadzka et al., 2021). One of these techniques is the LUNA- EMG (Samcom®), a device developed by the company EGZOTech specially designed for the rehabilitation of the upper and lower limbs in the neurology and orthopedic field. Robot-assisted rehabilitation, notably thanks to the EMG-LUNA robot, offers personalization of interventions to adapt to the specific needs of patients with neurological pathologies such as MS. The objective of this robot is to improve motor function, increase the range of movements and restore coordination and proprioception in these patients. It also makes it possible to measure muscle activity using sensors allowing electromyography (EMG), which objectively assesses the muscle function of the patient. In addition, the EMG-LUNA robot, thanks to its isokinetic dynamometer, allows adjusting movements during rehabilitation sessions depending on the individual force generated by the patient. This provides precise control of the motor behavior for effective rehabilitation (e.g., Oleksy et al., 2022).
Aim: This randomized controlled open-label study aims to assess the effects of the LUNA-EMG rehabilitation robot (RR) on MS patients’ muscular strength, balance and gait.
Methods: 35 patients with MS were randomly assigned to the RR (n=19) or the control group (n=16). The RR group received forty minutes of RR once a week for twelve weeks in place of one of their conventional physical therapy session, whereas the control group underwent conventional physical therapy only. Patients’ balance (Timed-Up and Go), speed (25 feet walking test), quadriceps (Q) and hamstring (H) muscular strengths and proprioception were collected at baseline, after four, eight and twelve weeks. We used two-way repeated measures ANOVAs to analyse the treatment effect and performed analyses in intention to treat (27 out of 35 patients completed all assessments).
MS patients were included in the study based on specific inclusion criteria to MS and common exclusion criteria defined for patients with MS and stroke. Recruitment was carried out at the CNRF (CHU of Lège). Of the 40 patients initially considered, 35 were able to be recruited to participate in the study (the 40 patients will be recruited by the end of the year). The inclusion criteria are as follows:
- The patient must have an EDSS score less than or equal to 6.5 and therefore still be capable to walk.
- The patient must not have had any flare-ups diagnosed in the last 3 months.
- The patient’s age must be between 18 and 70 years old.
- The patient must express the desire to participate in the study.
The exclusion criteria are as follows:
- The patient should not experience acute pain.
- The patient must not have severe cognitive deficit.
- The patient must not be exposed to a risk of fracture or suffer from an unrelated fracture consolidated.
- The patient's joints should not be excessively rigid (for example, due to spasticity, osteoarthritis or severe arthritis), nor, on the contrary, unstable.
- The patient must not suffer from severe ataxia or apraxia.
- The patient must not be epileptic.
- The patient must not have a pacemaker or other similar implants.
- The condition of the patient's skin must allow handling.
Results: Results revealed a statistically significant interaction between the effects of time and group regarding muscular strength for Q and H. Regarding H, post hoc Tukey tests revealed better scores at 4, 8 and 12 weeks compared to baseline within the RR group. Regarding Q, results also showed better scores in the RR group compared to the control group at 8 weeks. Other variables did not differ significantly between groups.
For your information, data relating to quality of life were also collected using the SF36 at baseline and at 12 weeks but we did not observe any changes between or within groups. Same for proprioception, collected at baseline + weeks 4, 8 and 12.
Discussion: Results show that RR improved MS patients’ muscular strength. Analyses will be confirmed once the total sample is collected (n=40).
