Tesis (Ingeniero Biomédico)

Parkinson’s disease (PD) is the second most common neurodegenerative disease in North
America and Europe. PD is a degenerative disease that affects these systems: central, peripheral, and enteric nervous, and has a significant impact on society, families and the quality of life
of the patients. Patients with PD have a variety of motor symptoms such as resting tremors,
rigidity, akinesia or bradykinesia and postural instability. Therefore, patients with PD need to
have a rehabilitation program to preserve current function, improve range of motion (RoM),
posture, strength and endurance, prevent disabling complications, and family training. This
work presents a biomechanical assessment of 12 patients with PD evaluated with the Hoehn
and Yahr scale before and after rehabilitation therapy for two months with robotic therapy
(Armeo®Spring exoskeleton). Patients performed three tests (Maximum Forward Reach,
Apley Scratching and Box and Block) where maximum angles, range of motion, angular
velocities, and execution times were measured. Nexus software (Oxford Metrics, Oxford, UK)
was used to track the trial data, and Polygon software (Oxford Metrics, Oxford, UK) provided
the kinematic outcomes of each user. Also, game scores are calculated with the Armeo therapy
report because it performs a quantitative analysis regarding the patient’s score in performing
the therapeutic games. A Wilcoxon test (p = 0.05) was performed to compare the variables
before and after the therapy for the more and less affected upper limbs. Also, averages and
standard deviations of game scores are calculated to compare the more and less affected
upper limbs before and after rehabilitation therapy. Significant differences were found in the
shoulder, elbow and wrist joints. The increase found was 15.89% for adduction-abduction
of the shoulder, 6.8% for flexion-extension of the elbow, and 26.82% for flexion-extension of
the wrist joint in the more affected upper limb before and after rehabilitation therapy in the
maximum forward reach test.
Regarding the minor affected upper limb, the increase found was 9.57% for flexionextension of the shoulder. On the other hand, in the Apley Scratching Test, the increase
found was 12.65% for flexion-extension of the elbow joint in the more affected upper limb
before and after rehabilitation therapy. Concerning the less affected upper limb, the increase
found was 14.79% for flexion-extension of the elbow joint. Finally, concerning the Box and
Block Test, the increase found was 9.13% for the flexion-extension of the elbow joint in the
more affected upper limb before and after rehabilitation therapy. In the less affected upper
limb, the increase found was 17.13% for the flexion-extension of the elbow joint. In conclusion, the Armeo therapy has been shown to improve motor skills reacquisition in upper limbs
through the performance of high intensity, high dose, and is repeatable, reliable and flexible.