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.