journal article·2025-02-26Open access

The Impact of RObotic Assisted Rehabilitation on Trunk Control in Patients with Severe Acquired Brain Injury (ROAR-sABI)

Letizia Castelli, Claudia Loreti, Anna Maria Malizia, Chiara Iacovelli, Sabina Renzi, Luca Fioravanti, Vincenza Amoruso, Ilaria Paolasso, Francesca Di Caro, Luca Padua, Silvia Giovannini

Applied Sciences· Volume 15· Issue 5

Abstract

Daily activities require balance and control posture. A severe Acquired Brain Injury (sABI) disrupts movement organization, control and execution, affecting trunk control and balance. Trunk control therapy for difficult patients requires known and novel methods. This study analyzes how hunova® robotic platform therapy affects sABI patients’ sitting balance and trunk control. Twenty-six sABI patients were randomized into the experimental group (HuG) that employed hunova® for trunk control in addition to traditional therapy and the control group (CoG) that received only conventional rehabilitation. Clinical assessments were performed for trunk, balance, cognitive and motor performance, disability, autonomy, quality of life, and fatigue. Both static and dynamic sitting balance and trunk control were assessed with hunova®. HuG and CoG were significant in intragroup analysis. Intergroup comparisons showed substantial differences in trunk control, affected side motor function, autonomy, quality of life, and fatigue. Only patients with HuG improved statistically in the instrumental assessment of trunk control and sitting balance. Between-group analysis showed that a statistically significant difference emerged in COP path and trunk movement. The study found effectiveness and adaptability of hunova® for trunk control rehabilitation, showing improvement in static and dynamic trunk control, motor function, autonomy, quality of life and fatigue in sABI patients. Registration: NCT05280587.
Source: crossref · Quality: baseline

Research context

OpenAlex topics: Stroke Rehabilitation and Recovery · EEG and Brain-Computer Interfaces · Cerebral Palsy and Movement Disorders

SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.

Affiliations

Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy

Department of Emergency, Anaesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy

UOS Riabilitazione Post-Acuzie, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy

Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy

Recovery and Functional Reducation Unit, Rehabilitation Department, Santa Corona Hospital, 17027 Pietra Ligure, Italy

UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy

References (54)

Show source-provided references
1. The Trunk’s Contribution to Postural Control under Challenging Balance Conditions10.1016/j.gaitpost.2020.11.020 ↗
2. Postural Balance and Physical Activity in Daily Life (PADL) in Physically Independent Older Adults with Different Levels of Aerobic Exercise Capacity10.1016/j.archger.2012.04.009 ↗
3. Okayama, Y., Maekawa, M., and Daikuya, S. (2024). Postural Control Strategies with Alterations in Visual Input Conditions in a Standing Position. Eur. J. Appl. Physiol.10.1007/s00421-024-05635-8 ↗
4. The Role of Core Stability in Athletic Function10.2165/00007256-200636030-00001 ↗
5. Trunk Training Exercises Approaches for Improving Trunk Performance and Functional Sitting Balance in Patients with Stroke: A Systematic Review
6. Relationship between Trunk Control, Core Muscle Strength and Balance Confidence in Community-Dwelling Patients with Chronic Stroke10.1080/10749357.2020.1783896 ↗
7. Sitting Balance: Its Relation to Function in Individuals with Hemiparesis10.1016/S0003-9993(96)90271-3 ↗
8. (2025, February 17). Linee Guida Del Ministero Della Sanità, L. G. D. M. per Le Attività Di Riabilitazione. Available online: https://www.gazzettaufficiale.it/eli/id/1998/05/30/098A4518/sg.
9. Trunk Performance after Stroke and the Relationship with Balance, Gait and Functional Ability10.1191/0269215505cr955oa ↗
10. Adult Clinical Neuropsychology: Lessons from Studies of the Frontal Lobes10.1146/annurev.psych.53.100901.135220 ↗
11. Perception of Vertical and Postural Control Following Stroke: A Clinical Study10.1016/j.physio.2004.11.008 ↗
12. Trunk Biomechanics during Hemiplegic Gait after Stroke: A Systematic Review10.1016/j.gaitpost.2017.03.004 ↗
13. The Effectiveness of Trunk Training on Trunk Control, Sitting and Standing Balance and Mobility Post-Stroke: A Systematic Review and Meta-Analysis10.1177/0269215519830159 ↗
14. Stabilization after Postural Transitions in the Elderly: Experimental Study on Community-Dwelling Subjects and Nursing Home Residents10.1016/j.gaitpost.2021.10.011 ↗
15. Altered Trunk Position Sense and Its Relation to Balance Functions in People Post-Stroke10.1097/NPT.0b013e3181660f0c ↗
16. Shumway-Cook, A., and Woollacott, M.H. (2007). Motor Control: Translating Research into Clinical Practice, Lippincott Williams & Wilkins.
17. Marchesi, G., Arena, G., Parey, A., De Luca, A., Casadio, M., Pierella, C., and Squeri, V. (2024). A Strong Core for a Strong Recovery: A Scoping Review of Methods to Improve Trunk Control and Core Stability of People with Different Neurological Conditions. Appl. Sci., 14.10.3390/app14114889 ↗
18. Physical Rehabilitation Approaches for the Recovery of Function and Mobility Following Stroke
19. Trunk Exercises Performed on an Unstable Surface Improve Trunk Muscle Activation, Postural Control, and Gait Speed in Patients with Stroke10.1589/jpts.28.940 ↗
20. The Effectiveness of Core Exercising for Postural Control in Patients with Stroke: A Systematic Review and Meta-Analysis
21. Core Stability Exercises in Addition to Usual Care Physiotherapy Improve Stability and Balance After Stroke: A Systematic Review and Meta-Analysis10.1016/j.apmr.2020.09.388 ↗
22. Effects of Core Training on Trunk Function, Balance, and Gait in Stroke Patients: A Systematic Review and Meta-Analysis of Randomised Controlled Trials10.1177/02692155221117220 ↗
23. The Effects of Core Stability Strength Exercise on Muscle Activity and Trunk Impairment Scale in Stroke Patients10.12965/jer.130042 ↗
24. The Effects of Core Stabilization Exercise on Dynamic Balance and Gait Function in Stroke Patients10.1589/jpts.25.803 ↗
25. Effect of Core Stability Training on Trunk Function, Standing Balance, and Mobility in Stroke Patients: A Randomized Controlled Trial10.1177/1545968316675431 ↗
26. The Effect of Additional Core Stability Exercises on Improving Dynamic Sitting Balance and Trunk Control for Subacute Stroke Patients: A Randomized Controlled Trial10.1177/0269215515609414 ↗
27. Effects of Core Stability Exercise on Rehabilitation in Stroke Patients with Hemiplegia: A Meta-Analysis10.53388/TMRND201801007 ↗
28. Robot-Assisted Therapy for Balance Function Rehabilitation after Stroke: A Systematic Review and Meta-Analysis10.1016/j.ijnurstu.2019.03.015 ↗
29. How Robot-Assisted Gait Training Affects Gait Ability, Balance and Kinematic Parameters after Stroke: A Systematic Review and Meta-Analysis10.23736/S1973-9087.24.08354-0 ↗
30. Effectiveness of Robotic Rehabilitation for Gait and Balance in People with Multiple Sclerosis: A Systematic Review10.1007/s00415-024-12715-4 ↗
31. De Luca, A., Squeri, V., Barone, L.M., Vernetti Mansin, H., Ricci, S., Pisu, I., Cassiano, C., Capra, C., Lentino, C., and De Michieli, L. (2020). Dynamic Stability and Trunk Control Improvements Following Robotic Balance and Core Stability Training in Chronic Stroke Survivors: A Pilot Study. Front. Neurol., 11.10.3389/fneur.2020.00494 ↗
32. The Italian Version of the Trunk Impairment Scale: Development and Psychometric Properties10.23736/S1973-9087.17.04371-4 ↗
33. The Balance Scale: Reliability Assessment with Elderly Residents and Patients with an Acute Stroke10.2340/1650197719952736 ↗
34. Pavasini, R., Guralnik, J., Brown, J.C., di Bari, M., Cesari, M., Landi, F., Vaes, B., Legrand, D., Verghese, J., and Wang, C. (2016). Short Physical Performance Battery and All-Cause Mortality: Systematic Review and Meta-Analysis. BMC Med., 14.10.1186/s12916-016-0763-7 ↗
35. Criterion Validity of Lower Extremity Motricity Index Scores10.1191/026921500675786655 ↗
36. Test-Retest Reliability of Motricity Index Strength Assessments for Lower Extremity in Post Stroke Hemiparesis
37. Levels of Cognitive Functioning Assessment Scale: Italian Cross-Cultural Adaptation and Validation
38. Reliability and Validity of the Disability Rating Scale and the Levels of Cognitive Functioning Scale in Monitoring Recovery from Severe Head Injury
39. Disability Rating Scale for Severe Head Trauma: Coma to Community
40. Improving the Sensitivity of the Barthel Index for Stroke Rehabilitation10.1016/0895-4356(89)90065-6 ↗
41. The Barthel ADL Index: A Reliability Study10.3109/09638288809164103 ↗
42. EuroQol-5D (EQ-5D): An Instrument for Measuring Quality of Life
43. EQ-5D and the EuroQol Group: Past, Present and Future10.1007/s40258-017-0310-5 ↗
44. Psychometric Properties of the Fatigue Severity Scale and the Modified Fatigue Impact Scale10.1016/j.jns.2013.05.023 ↗
45. Tired of Not Knowing What That Fatigue Score Means? Normative Data of the Modified Fatigue Impact Scale (MFIS)10.1016/j.msard.2020.102576 ↗
46. Saglia, J.A., De Luca, A., Squeri, V., Ciaccia, L., Sanfilippo, C., Ungaro, S., and Michieli, L. (2019, January 24–28). De Design and Development of a Novel Core, Balance and Lower Limb Rehabilitation Robot: Hunova®. Proceedings of the IEEE 16th International Conference on Rehabilitation Robotics (ICORR), Toronto, ON, Canada.10.1109/ICORR.2019.8779531 ↗
47. Castelli, L., Iacovelli, C., Ciccone, S., Geracitano, V., Loreti, C., Fusco, A., Biscotti, L., Padua, L., and Giovannini, S. (2023). RObotic-Assisted Rehabilitation of Lower Limbs for Orthopedic Patients (ROAR-O): A Randomized Controlled Trial. Appl. Sci., 13.10.3390/app132413208 ↗
48. Robotic-Assisted Rehabilitation for Balance in Stroke Patients (ROAR-S): Effects of Cognitive, Motor and Functional Outcomes
49. RObotic-Assisted Rehabilitation for Balance and Gait in Stroke Patients (ROAR-S): Study Protocol for a Preliminary Randomized Controlled Trial10.1186/s13063-022-06812-w ↗
50. Sample Size of 12 per Group Rule of Thumb for a Pilot Study10.1002/pst.185 ↗
51. What Do Motor “Recovery” and “Compensation” Mean in Patients Following Stroke?10.1177/1545968308328727 ↗
52. Compensatory Strategies for Reaching in Stroke10.1093/brain/123.5.940 ↗
53. Deep Learning-Driven Analysis of a Six-Bar Mechanism for Personalized Gait Rehabilitation10.1115/1.4066859 ↗
54. Transformer-Based Approach for Predicting Transactive Energy in Neurorehabilitation10.1109/TNSRE.2024.3515175 ↗