ArticlesEffects of robotic therapy on motor impairment and recovery in chronic stroke☆
Abstract
Fasoli SE, Krebs HI, Stein J, Frontera WR, Hogan N. Effects of robotic therapy on motor impairment and recovery in chronic stroke. Arch Phys Med Rehabil 2003;84:477-82. Objective: To examine whether robotic therapy can reduce motor impairment and enhance recovery of the hemiparetic arm in persons with chronic stroke. Design: Pre-posttest design. Setting: Rehabilitation hospital, outpatient care. Participants: Volunteer sample of 20 persons diagnosed with a single, unilateral stroke within the past 1 to 5 years, with persistent hemiparesis. Interventions: Robotic therapy was provided 3 times weekly for 6 weeks. Subjects able to reach robot targets were randomly assigned to sensorimotor or progressive-resistive robotic therapy groups. Robotic therapy consisted of goal-directed, planar reaching tasks to exercise the hemiparetic shoulder and elbow. Main Outcome Measures: The Modified Ashworth Scale, Fugl-Meyer test of upper-extremity function, Motor Status Scale (MSS) score, and Medical Research Council motor power score. Results: Evaluations by a single blinded therapist revealed statistically significant gains from admission to discharge (P[lt].05) on the Fugl-Meyer test, MSS score, and motor power score. Secondary analyses revealed group differences: the progressive-resistive therapy group experienced nonspecific improvements on wrist and hand MSS scores that were not observed in the sensorimotor group. Conclusions: Robotic therapy may complement other treatment approaches by reducing motor impairment in persons with moderate to severe chronic impairments.
References (0)
Cited by (418)
Resistive versus active assisted robotic training for the upper limb after a stroke: A randomized controlled study
2024, Annals of Physical and Rehabilitation MedicineSelection of a suitable training modality according to the status of upper limb function can maximize the effects of robotic rehabilitation; therefore, it is necessary to identify the optimal training modality.
This study aimed to compare robotic rehabilitation approaches incorporating either resistance training (RET) or active-assisted training (AAT) using the same rehabilitation robot in people with stroke and moderate impairment.
In this randomized controlled trial, we randomly allocated 34 people with stroke who had moderate impairment to either the experimental group (RET, n = 18) or the control group (AAT, n = 16). Both groups performed robot-assisted therapy for 30 min, 5 days per week, for 4 weeks. The same rehabilitation robot provided resistance to the RET group and assistance to the AAT group. Body function and structure, activity, and participation outcomes were evaluated before, during, and after the intervention.
RET led to greater improvements than AAT in terms of smoothness (p = 0.006). The Fugl-Meyer Assessment (FMA)-upper extremity (p < 0.001), FMA-proximal (p < 0.001), Action Research Arm Test-gross movement (p = 0.011), and kinematic variables of joint independence (p = 0.017) and displacement (p = 0.011) also improved at the end of intervention more in the RET group.
Robotic RET was more effective than AAT in improving upper limb function, structure, and activity among participants with stroke who had moderate impairment.
The Combined Effect of Robot-assisted Therapy and Activities of Daily Living Training on Upper Limb Recovery in Persons With Subacute Stroke: A Randomized Controlled Trial
2024, Archives of Physical Medicine and RehabilitationTo evaluate the effectiveness of robot-assisted therapy (RAT) followed by activities of daily living (ADL) training in comparison with conventional rehabilitation therapy (CRT) and ADL training in individuals with subacute stroke.
A single-blind, 2-arm, parallel-group, open-level, randomized controlled trial.
A tertiary care teaching hospital in India.
Forty-four persons (n=44) with first-ever stroke (in subacute stage) were enrolled from August 2021 to July 2023.
Participants in the RAT group (n=22) received RAT for 30 minutes, followed by ADL training for 30 minutes. In contrast, participants in the CRT group (n=22) received CRT (30 minutes) followed by ADL training (30 minutes). Both groups received allocated interventions for 15 days over 3 weeks (5 days/week, 3 weeks).
Primary outcome: Motor domain score of the Fugl-Meyer Assessment scale for upper extremity (FMA-UE). Secondary outcomes: the other domains scores of FMA-UE (UL -sensation, -joint motions, -joint pain); Modified Ashworth Scale (MAS) (spasticity); hand-function (HF) and ADL-domain scores of the stroke impact scale (SIS); WHOQQL-BREF questionnaires (QOL). Participants were assessed at enrolment and follow-up at 3, 6, and 12 weeks.
Persons who received RAT and ADL training reported significant improvement (P<.05) in UL motor function (mean difference [MD]=3.54;(95% confidence interval [CI]: 1.28 to 5.79]), UL passive joint motions (MD=2.54; [95% CI: 1.56 to 3.52]), SIS-HF (MD=6.37;[95% CI: 4.75 to 7.99]), SIS-ADL (MD=7.13 [95% CI: 3.52 to 8.74]), and in all domains of WHOQOL-BREF (except environmental domain) compared with persons who received CRT and ADL training at 12 weeks.
The findings indicate that RAT followed by ADL training is more effective than CRT followed by ADL training in motor improvement, SIS-HF, SIS-ADL, and QOL at 12 weeks.
Efficacy of Robot-Assisted Training on Rehabilitation of Upper Limb Function in Patients With Stroke: A Systematic Review and Meta-analysis
2023, Archives of Physical Medicine and RehabilitationTo systematically evaluate the effect of robot-assisted training (RAT) on upper limb function recovery in patients with stroke, providing the evidence-based medical basis for the clinical application of RAT.
We searched online electronic databases up to June 2022, including PubMed, The Cochrane Library, Scopus, Web of Science, EMBASE, WanFang Data, CNKI, and VIP full-text databases.
Randomized controlled trials of the effect of RAT on upper extremity functional recovery in patients with stroke.
The Cochrane Collaboration Tool for Assessing the Risk of Bias was used to assess study quality and risk of bias.
Fourteen randomized controlled trials involving 1275 patients were included for review. Compared with the control group, RAT significantly improved upper limb motor function and daily living ability. The overall differences were statistically significant, Fugl-Meyer Assessment for the Upper Extremity (FMA-UE; standard mean difference=0.69; 95% confidence interval, 0.34, 1.05; P=.0001), modified Barthel Index (standard mean difference=0.95; 95% confidence interval, 0.75, 1.15; P<.00001), whereas the differences in modified Ashworth Scale, FIM, and Wolf Motor Function Test scores were not statistically significant.
Compared with the control group, the differences between FMA-UE and modified Barthel Index at 4 and 12 weeks of RAT, there were statistically significant, the differences of FMA-UE and modified Ashworth Scale in patients with stroke in the acute and chronic phases were statistically significant.
The present study showed that RAT can significantly enhance the upper limb motor function and activities of daily life in patients with stroke undergoing upper limb rehabilitation.
External six-bar mechanism rehabilitation device for index finger: Development and shape synthesis
2023, Robotics and Autonomous SystemsThis work proposes a novel external Stephenson-III six-bar mechanism-based rehabilitation device. This device has been designed to rehabilitate the patient’s finger for the action of grabbing, also known as flexion and extension. A predefined trajectory is used to synthesize the mechanism using TeachingLearning-Optimization algorithm (TLBO) and Particle swarm optimization algorithm (PSO). The trajectory data was obtained after image processing by grabbing a particular object 30 times to record the flexion and extension motion of the index finger. An optimization problem was formulated and results of TLBO and PSO were compared. The mechanism obtained from TLBO algorithm was deemed better in terms of precision and feasible configuration. Using clinical biomechanical data for flexion/extension of index finger, position and static force analysis are performed. The CAD model of the mechanism was then tested for feasibility in a CAD/Software. Excess mass was removed using topology optimization and a 20% mean reduction for every link was achieved. An index finger rehabilitation device employing an external six-bar mechanism was obtained, that would help a patient with motor control loss to rehabilitate and bring normalcy to life. The design of exoskeleton was able to match the trajectory of the index. Shape synthesis ensured a 20% reduction in overall mass of the linkages.
Digital transformation in robotic rehabilitation and smart prosthetics
2023, Digital Transformation in Healthcare in Post-COVID-19 TimesOngoing improvement in smart prosthetic and rehabilitative gadgets has focused on further developing human-machine interactions. In robotic rehabilitation, controlled exoskeletons and artificial limbs are intended to help individuals affected by spinal cord injury, amputation, and different neurodegenerative diseases. In present era, prosthetics and robotic rehabilitation are progressively ready to detect and think so they can interact with the human sensing environment and neural signaling with such ease prompting the neural movement reaction. Its myoneural interface empowers amputees to walk all the more normally and practically with no actual limitations. Mechanical restoration frequently incorporates and coordinates all the fundamental data from sensors such as EMG and touch sensors, encoding them and producing functional movements as required. Aside from this, it is planned by the adaptability of the clients. It examines the use of robotics in sensory as well as motor recovery and creates mechatronic help for developmental inabilities. In this section, we will focus on its function, method of utilization, and progress identified in robotic rehabilitation in the field of physical disabilities. This section will likewise include the role of advanced robotics for everyday life and how it can assist with the quality of living of the debilitated populace.
The effect of Electromyography (EMG)-driven Robotic Treatment on the recovery of the hand Nine years after stroke
2023, Journal of Hand TherapyTo investigate the effect of electromyography (EMG)-driven robotic therapy on the recovery of the hand in a stroke case lasting 9 years.
An 18-year-old patient with hemiparesis due to the ischemic lesion was admitted to our clinic with hand impairment. Fifteen sessions (5 weeks x 3 times) of robotic rehabilitation were applied with the Hand of Hope. Average EMG (mV) of flexor digitorum superficialis (FDS) muscle, average force (N) and the rate of force development (RFD)(N/s) were also assessed before and after the treatment following the 5th and 10th sessions and at the end of treatment. Also, Fugl-Meyer Assessment of Upper Extremity Scale (FMU-UE), Motor Activity Log (MAL), Canadian Occupational Performance Score (COPM) and Visual Analog Scale (VAS) were used for assessment before and after the treatment.
The average EMG measured from FDS increased from 0.093-0.133 mV. The average force and average RFD increased from 45.6-97.7 and from 135.6-172.6 respectively. While affected and/or unaffected side force ratio increased dramatically from 54%-82%, the FMA-UE score increased from 56-59. The MAL quality of use score increased from 3.93-4.13. Performance and satisfaction scores of COPM changed from 5.25-7.25 and 4.5-8.25 respectively. VAS score for fatigue changed from 6 to 4.
The improvement achieved 9 years later with 15 sessions of rehabilitation suggests that improvement may be possible for chronic stroke patients.
- ☆
Supported by the National Institute of Child Health and Human Development, National Institutes of Health (grant nos. R01-HD-36827, R01-HD-37397), the Burke Medical Research Institute, and a National Research Service Award, the National Institute of Child Health and Human Development, National Institute of Health (grant no. F32 HD41795-01).