Adaptive robot training in the rehabilitation of incoordination in Multiple Sclerosis: a pilot study

Cerebellar symptoms are extremely disabling, and are common in patients with Multiple Sclerosis (MS); at present, no effective treatments are available. This pilot study aims at developing and assessing a novel robot therapy protocol, aimed at the rehabilitation of subjects with MS and impaired coordination. Subjects performed planar reaching movements while grasping the handle of a robotic manipulandum, which generated forces that either reduced or enhanced the patterns of curvature of the subjects' movements, observed at the beginning of each session. Therefore, the protocol was designed to adapt to each patient, and to the improvements - if any - from session to session. We tested a total of four subjects, with clinically defined MS and cerebellar symptoms at the upper limb. Each subject went through two blocks of sessions, four error-reducing and four error-enhancing (2 sessions/week). All subjects displayed a preserved ability to adapt to the robot-generated forces. Moreover, after training, their movements became faster, smoother, and with a more symmetric speed profile. Over sessions, we observed an improved sensorimotor performance and a reduction of cerebellar symptoms. These results support the claim that rehabilitation, in general, and adaptive robot training in particular may be beneficial to subjects with MS and impaired coordination.