Robotic rehabilitation in clinical complications after breast cancer: exoskeleton of upper limbs
DOI:
https://doi.org/10.11606/issn.2176-7262.rmrp.2024.216066Keywords:
Breast cancer, Exoskeleton Device, Electromyography, Pain, Range of motionAbstract
Background: Breast cancer promotes several physical and functional changes. Innovative techniques of physiotherapeutic treatment, such as robotic rehabilitation may contribute to the prevention or treatment of these complications. Here we aim to evaluate the effects of robotic rehabilitation on clinical complications secondary to breast cancer. Methods: This is a longitudinal clinical study consisting of 26 subjects divided into the following groups: 13 patients (women after breast cancer - G1, Robotic Rehabilitation Group) and 13 healthy women who did not undergo surgery due to breast cancer and constituted the GC (Control Group) to obtain data from electromyography and dynamometry. Ten consecutive therapeutic sessions were performed. The following parameters were evaluated in three sessions (session 1 - S1, session 5 - S5 and session 10 - S10): scapular and manual force, myoelectric activity, pain, range of motion, lymphedema
and quality of life. Results: Pain threshold attenuation was obtained by comparing S5 with S10 (p = 0.002) and at the end of treatment (p = 0.01); lymphedema reduction after 10 sessions (p = 0.04); increase of abduction ROM when comparing S1 with S10 (p = 0.05); flexion (p = 0.002) in S1 in relation to S10 and shoulder extension (p = 0.05) in S5. Regarding the electromyographic analysis, there were increases in scapular and manual force of the GC versus G1, and changes in variables estimated from the collected signals, especially the increase in signal amplitude for the MAV, PEAK and RMS characteristics of the brachial biceps muscles, anterior and middle deltoid when comparing S1 versus S10. Before the evaluation using the dynamometer, the healthy women presented increase of scapular and manual force in relation to the volunteers after breast cancer. Conclusion: The use of robotic therapy was significantly efficient for pain attenuation, lymphedema, increase range of motion, increased recruitment of muscle fibers and improvement of muscle synergism, which contributed to the improvement of the quality of life.
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References
Ministério da Saúde. Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA). Estimativa 2023 – Incidência de Câncer no Brasil. Rio de Janeiro: INCA; 2022.
Santos MO, et al. Estimativa de Incidência de Câncer no Brasil 2023-2025. RBC. 2023;69(1):e-213700. Availabre from: https://doi.org/10.32635/2176-9745.RBC.2023v69n1.3700.
Izci F, et al. Pre-Treatment and Post-Treatment Anxiety, Depression, Sleep and Sexual Function Levels in Patients with Breast Cancer. Eur J Breast Health. 2020; 16(3):219-225. Availabre from: 10.5152/ejbh.2020.5259.
Smedsland SK, et al. Sexual activity and functioning in long term breast cancer survivors; exploring associated factors in a nationwide survey. Breast Cancer Res T. (2022)193:139–149. Availabre from: https://doi.org/10.1007/s10549-022-06544-0.
Wilson DJ. Exercise for the patient after breast cancer surgery. Semin Oncol Nurs, 2017; XX(XX):1-8.
Morone G, Iosa M, Fusco A, Scappaticci A, Alcuri MR, Saraceni VM, et al. Effects of a multidisciplinary educational rehabilitative intervention in breast cancer survivors: the role of body image on quality of life outcomes. Sci World J Journal. 2014; 2014(1-11).
Gritsenko V, Dailey E, Kyle N, Taylor M, Whittacre S, Swisher AK. Feasibility of using low-cost motion capture for automated screening of shoulder motion limitation after breast cancer surgery. Plos One, 2015; 10(6):1-9.
Larsson IM, Sorensen JA, Bille C. The Post-mastectomy Pain Syndrome - A Systematic Review of the Treatment Modalities. Breast J. 2017; XX(XX): 1-6.
De Groef A, Van Kampen M, Dieltjens E, Christiaens MR, Neven P, Geraerts I, et al. Effectiveness of postoperative physical therapy for upper limb impairments following breast cancer treatment: a systematic review. Arch Phys Med Rehabil. 2015;96(6): 1140-1153.
Longhi M, Merlo A, Prati P, Giacobbi M, Mazzoli D. Instrumental indices for upper limb function assessment in stroke patients: a validation study. J Neuroeng Rehabil. 2016;13(52):1-11.
Pan L, Song A, Duan S, Yu S. Patient-Centered Robot-Aided Passive Neurorehabilitation Exercise Based on Safety-Motion Decision-Making Mechanism. Biomed Res Int. 2017; 2017:1-11.
Seniam - Surface ElectroMyoGraphy for the Non-Invasive Assessment of Muscles. Biomedical Health and Research Program (BIOMED II) of the European Union. http://www.seniam.org/
Akoochakian M, Davari HA, Alizadeh MH, Rahnama N. Evaluation of shoulder girdle strength more than 12 month after modified radical mastectomy and axillary nodes dissection. J Res Med Sci. 2017;22(81):1-10.
Ciconelli RM, Ferraz MB, Santos W, Meinão I, Quaresma MR. Tradução para a língua portuguesa e validação do questionário genérico de avaliação de qualidade de vida SF-36 (Brasil SF-36). Rev Bras Reumatol. 1999; 39(3):143-150.
Pimenta FAP, Simil FF, Tôrres HOG, Amaral CFS, Rezende CF, Coelho TO, et al. Avaliação da qualidade de vida de aposentados com a utilização do questionário SF-36. Rev Assoc Med Bras. 2018;54(1):55-60.
Pana CF, Popescu D, Radulescu, VM. Patent Review of Lower Limb Rehabilitation Robotic Systems by Sensors and Actuation Systems Used. Sensors. 2023(23):6237. Doi: https://doi.org/10.3390/s23136237.
Levin MF, Weiss PL, Keshner EA. Emergence of virtual reality as a tool for upper limb rehabilitation: incorporation of motor control and motor learning principles. Phys Ther. 2015; 95(3): 415-425.
Hatem SM, Saussez G, Della Faille M, Prist V, Zhang X, Dispa D, et al. Rehabilitation of motor function after stroke: a multiple systematic review focused on techniques to stimulate upper extremity recovery. Front Hum Neurosci. 2016; 10(442):1-22.
Vigotsky AD, Halperin I, Lehman GJ, Trajano GS, Vieira TM. Interpreting signal amplitudes in surface electromyography studies in sport and rehabilitation sciences. Front Physiol. 2018;8(985):1-15.
Monleon S, Ferrer M, Tejero M, Pont A, Piqueras M, Belmonte R. Shoulder strength changes one year after axillary lymph node dissection or sentinel lymph node biopsy in breast cancer patients. Arch Phys Med Rehabil. 2016; 97(6): 953-963.
Peres LB. Classificação de atividade eletromiográfica facial de indivíduos saudáveis e com hanseníase por meio de máquina de vetores de suporte. 2016. Dissertação (Mestrado em Engenharia Biomédica) – Universidade Federal de Uberlândia, Uberlândia, 2016.
Zhang Q, Liu R, Chen W, Xiong C. Simultaneous and Continuous Estimation of Shoulder and Elbow Kinematics from Surface EMG Signals. Front Neurosci. 2017; 11(280):1-12.
Xi X, Tang M, Miran SM, Luo Z. Evaluation of feature extraction and recognition for activity monitoring and fall detection based on Wearable sEMG sensors. Sensors, 2017;17(1229): 1-20.
Adewuyi AA, Hargrove LJ, Kuiken TA. Evaluating EMG feature and classifier selection for application to partial-hand prosthesis control. Front Neurorobot. 2016; 10(15):1-11.
Manikandan S. Measures of dispersion. J Pharmacol Pharmacother. 2011; 2(4):315-316.
Recchia TL, Prim AC, Luz M. Upper limb functionality and quality of life in women with five-year survival after breast cancer surgery. Rev Bras Ginecol Obstet. 2017;39(3): 115-122.
Gonçalves JS, Moriguchi CS, Takekawa KS, Coury HJCG, Sato TO. The effects of forearm support and shoulder posture on upper trapezius and anterior deltoid activity. J. Phys Ther Sci. 2017;29(5):793-798.
Haddad CA, Saad M, Perez Mdel C, Miranda Júnior F. Assessment of posture and joint movements of the upper limbs of patients after mastectomy and lymphadenectomy. Einstein. 2013;11(4):426-434.
Shamley D, Lascurain-aguirrebena I, Oskrochi R. Clinical anatomy of the shoulder after treatment for breast cancer. Clin Anat, 2014;27:467-477.
Shamley D, Lascurain-Aguirrebeña I, Oskrochi R, Srinaganathan R. Shoulder morbidity after treatment for breast cancer is bilateral and greater after mastectomy. Acta Oncol. 2012; 51:1045-1053.
Díaz IR, Torres ML, Cerezo ET, Díaz Del Campo CG, Gutiérrez CO. Accessory joint and neural mobilizations for shoulder range of motion restriction after breast cancer surgery: a pilot randomized clinical trial. J Chiropr Med. 2017; 16(1): 31-40.
Lewis PA, Cunningham JE. Dynamic Angular Petrissage as Treatment for Axillary Web Syndrome Occurring after Surgery for Breast Cancer: a Case Report. Int. J. Ther. Massage Bodywork, 2016; 9(2):28-37.
Huang HC, Liu HH, Yin LY, Yeh CH, Tu CW, Yang CS. The upper-limb volumetric changes in breast cancer survivors with axillary web syndrome. Eur J Cancer Care, 2017;26(2): 1-6.
Scaffidi M , Vulpiani MC , Vetrano M , Conforti F , Marchetti MR , Bonifacino A , et al. Early rehabilitation reduces the onset of complications in the upper limb following breast câncer surgery. Eur J Phys Rehabil Med. 2012; 48(4):601-611.
Ezzo J, Manheimer E, McNeely ML, Howell DM, Weiss R, Johansson KI, et al. Manual lymphatic drainage for lymphedema following breast cancer treatment. Cochrane Database Syst Rev. 2016; 5:1-73.
House G, Burdea G, Grampurohit N, Polistico K, Roll D, Damiani F. A feasibility study to determine the benefits of upper extremity virtual rehabilitation therapy for coping with chronic pain post-cancer surgery. J Pain, 2016; 10(4): 186-197.
Hansdorfer-Korzon R, Teodorczyk J, Gruszecka A, Lass P. Are compression corsets beneficial for the treatment of breast cancer-related lymphedema? New opportunities in physiotherapy treatment – a preliminary report. Onco. Targets Ther. 2016; 2016 (9):2089-2098.
Tang W, Li Z, Tang C, Wang X, Wang H. Health literacy and functional exercise adherence in postoperative breast cancer patients. Patient Prefer Adherence, 2017; 11:781-786.
Sharma N, Radiotherapy MD, Purkayastha A. Impact of radiotherapy on psychological, financial, and sexual aspects in postmastectomy carcinoma breast patients: a prospective study and management. Asia Pac. J. Oncol. Nurs. 2017; 4(1): 69-76.
Ahmed AE, Alharbi AG, Alsadhan MA, Almuzaini AS, Almuzaini HS, Ali YZ, et al. The predictors of poor quality of life in a sample of Saudi women with breast cancer. Breast Cancer (Dove Med Press). 2017; 9: 51-58.
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Copyright (c) 2024 Izabela dos Santos Mendes, Fabio Henrique Monteiro Oliveira, Gabriela Aparecida de Souza, Thaisa Prado Sene, Fernanda Pupio Silva Lima, Adriano de Oliveira Andrade, Mario Oliveira Lima

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