Abstract

The recovery of upper extremity (UE) function after stroke is slower and less complete than return of mobility. Neuroplasticity is the key mechanism underlying improvement in functional outcome after stroke. Robotic devices can stimulate neuroplasticity by providing high-intensity, repetitive, task-specific training.

Aim of this prospective randomized controlled study was to evaluate the efficacy of Robot-assisted therapy as an adjunct to conventional rehabilitation program in management of UE weakness in stroke patients in terms of motor recovery & functional outcome.

Sixty four patients, having stroke duration less than two years, included in the study (n=64) and divided in two groups. Thirty two subjects in control group received conventional rehabilitation program & thirty two in study group additionally received Robot-assisted therapy using over four weeks. Assessment was done pre-treatment, at 1 month & at 4 months. The outcome measures were:Fugl-Meyer Assessment(FMA) score for upper extremity & Motor Activity Log scale(MAL) comprising of Amount of Use(AOU) score and Quality of Use (QOU) score.

Chi-Square test and paired t test were used. Results were considered significant at 5% that is P value<0.05.

The study group exhibited greater motor recovery than the control group on the FMA scores at 1month and 4months. The mean AOU and QOS scores of MAL in the study group were also better than that of control group at 1month and 4months.

So it can be concluded thatRobot-assisted therapy can be used as a complement to conventional therapy for improving UE function in stroke.

Keywords: Stroke, Rehabilitation, Robotics, Upper extremity.

1.      Halder P, Sterr A, Brem S, Bucher K, Kollias S, Brandeis D.Electrophysiological evidence for cortical plasticity with movement repetition. Eur J Neurosci2005;21:2271-7.

2.      Lum PS, Burgar CG, Shor PC, Majmundar M. Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke. Arch Phys Med Rehabil 2002;83(7):952-59.

3.      Housman SJ, Scott KM, Reinkensmeyer DJ. A Randomized Controlled Trial of Gravity-Supported, Computer-Enhanced Arm Exercise for Individuals with Severe Hemiparesis. Neurorehabil Neural Repair 2009;23(5):505-14.

4.      Reinkensmeyer DJ, Wolbrecht ET, Chan V, Chou C, Cramer SC, Bobrow JE. Comparison of three dimentional, assist-as-needed robotic arm/ hand movement training provided with Pneu-WREX to conventional tabletop therapy after chronic stroke. Am J Phys Med Rehabil 2012;91 (Suppl):S232-41.

5.      Krebs HI, Hogan N: Robtic therapy: The tipping point. Am J Phys Med Rehabil 2012;91(Suppl):S290-97.

6.      Conroy SS, Whitall J, Dipietro L, Lauren M, Jones-Lush, Zhan M, Finley MA, Wittenberg GF, Krebs HI, Bever CT. Effect of Gravity on Robot-Assisted Motor Training After Chronic Stroke: A Randomized Trial. Arch Phys Med Rehabil 2011;92(11):1754-61.

7.      Iwamuro BT, Cruz EG, Connelly LL, Fischer HC, Kamper DG. Effect of a Gravity-Compensating Orthosis on Reaching After Stroke: Evaluation of the Therapy Assistant WREX. Arch Phys Med Rehabil 2008;89:2121–28.

8.      Lo AC, Guarino PD, Richards LG, Haselkorn JK, Wittenberg GF, Federman DG, Ringer RJ, Wagner TH, Krebs HI, Volpe BT, Bever CT, Bravata DM, Duncan PW, Corn BH, Maffucci AD, Nadeau SE, Conroy SS, Powell JM, Huang GD, Peduzzi P. Robot-Assisted Therapy for Long-Term Upper-Limb Impairment after Stroke. N Engl J Med 2010; 362:1772-83.

9.      Van Peppen R, Kwakkel G, Wood-Dauphinee S, Hendriks H, Van der Wees P, Dekker J: The impact of physical therapy on functional outcomesafter stroke: what’s the evidence? Clin Rehabilitation2004;18(8):833–62.

10.  Paolucci S, Antonucci G, Grasso M, Morelli D, Troisi E, Coiro P, Bragoni M: Early versus delayed inpatient stroke rehabilitation: a matchedcomparison conducted in Italy. Arch Phys Med and Rehabil2000;81(6):695–700.

11.  Jorgensen HS, Nakayama H, Raaschou HO. Outcome and time course of recovery in stroke. Part II: time course of recovery. The Copenhagen Stroke Study. Arch Phys Med Rehabil1995;76:406-12.

12.  Luft AR, Mccombe-Waller S, Whitall J, Forrester LW, Macko R, Sorkin JD, et al. Repetitive bilateral arm training and motor cortex activation in chronic stroke. A randomized controlled trial. J Am Med Assoc 2004;292(15):1853–61.

13.  Nudo RJ, Wise BM, SiFuentes F. Neural substrates for the effects of rehabilitative training on motor recovery after ischemic infarct. Science 1996;272:1791-94.

14.  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.

15.  Maserio S, Celia A, Rosati G, Armani M. Robotic-Assisted Rehabilitation of the Upper Limb After Acute Stroke. Arch Phys Med Rehabil 2007;88:142-49.

16.  Wagenaar RC, Meijer OG. Effects of stroke rehabilitation. I: A critical review of the literature. J RehabilSci 1991;4:61-73.

17.  Takahashi CD, Der-Yeghiaian L, Vu Le, Motiwala RR, Cramer SC. Robot-based hand motor therapy after stroke. Brain 2008;131:425-37.

18.  Kwakkel G, Kollen BJ, Krebs HI. Effects of Robot-Assisted Therapy on Upper Limb Recovery after Stroke: A Systematic Review. Neurorehabil Neural Repair2008; 22: 111.

19.  Volpe BT, Lynch D, Rykman-Berland A, Ferraro M, Galgano M, Hogan N, Hermano I. Intensive Sensorimotor Arm Training Mediated by Therapist or Robot Improves Hemiparesis in Patients. Neurorehabil Neural Repair 2008;22 (3):305-10.

20.  Robertson JVG, Jarrasse N, Roby-Brami A. Rehabilitation robots: a compliment to virtual reality. Schedae 2010; prepublication n⁰ 6 (fascicule n⁰1): 77-94.