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Robotic-assisted rehabilitation of the upper limb after acute stroke.
Arch Phys Med Rehabil. 2007 Feb; 88(2):142-9.AP

Abstract

OBJECTIVE

To investigate whether early therapy with a novel robotic device can reduce motor impairment and enhance functional recovery of poststroke patients with hemiparetic and hemiplegic upper limb.

DESIGN

A single-blind randomized controlled trial, with an 8-month follow-up.

SETTING

Neurologic department and rehabilitation hospital.

PARTICIPANTS

Thirty-five patients with acute (< or =1 wk of onset), unilateral, ischemic embolic, or thrombotic stroke.

INTERVENTIONS

Patients of both groups received the same dose and length per day of standard poststroke multidisciplinary rehabilitation. Patients were randomly assigned to 2 groups. The experimental group (n=17) received additional early sensorimotor robotic training, 4 hours a week for 5 weeks; the control group (n=18) was exposed to the robotic device, 30 minutes a week, twice a week, but the exercises were performed with the unimpaired upper limb. Training by robot consisted of peripheral manipulation of the shoulder and elbow of the impaired limb, correlated with visual stimuli.

MAIN OUTCOME MEASURES

The Fugl-Meyer Assessment (FMA) of upper-extremity function (shoulder/elbow and coordination and wrist/hand subsections) to measure each trained limb segment; the Medical Research Council (MRC) score to measure the strength of muscle force during 3 actions: shoulder abduction (MRC deltoid), elbow flexion (MRC biceps), and wrist flexion (MRC wrist flexors); the FIM instrument and its motor component; and the Trunk Control Test (TCT) and Modified Ashworth Scale (MAS).

RESULTS

Compared with the patients in the control group, the experimental group showed significant gains in motor impairment and functional recovery of the upper limb after robot therapy, as measured by the MRC deltoid (P< or =.05) and biceps (P<.05) scores, the FMA for the proximal upper arm (P<.05), the FIM instrument (P<.05), and the FIM motor score (P<.01); these gains were also sustained at the 3- and 8-month follow-up. The FMA and MRC wrist flexor test findings did not differ statistically either at the end of training or at the follow-up sessions. We found no significant differences in MAS and TCT in either group in any of the evaluations. No adverse effects occurred and the robotic approach was very well accepted.

CONCLUSIONS

Patients who received robotic therapy in addition to conventional therapy showed greater reductions in motor impairment and improvements in functional abilities. Robotic therapy may therefore effectively complement standard rehabilitation from the start, by providing therapeutic support for patients with poststroke plegic and paretic upper limb.

Authors+Show Affiliations

Department of Rehabilitation Medicine, University of Padova, School of Medicine, Padova, Italy. stef.masiero@unipd.itNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17270510

Citation

Masiero, Stefano, et al. "Robotic-assisted Rehabilitation of the Upper Limb After Acute Stroke." Archives of Physical Medicine and Rehabilitation, vol. 88, no. 2, 2007, pp. 142-9.
Masiero S, Celia A, Rosati G, et al. Robotic-assisted rehabilitation of the upper limb after acute stroke. Arch Phys Med Rehabil. 2007;88(2):142-9.
Masiero, S., Celia, A., Rosati, G., & Armani, M. (2007). Robotic-assisted rehabilitation of the upper limb after acute stroke. Archives of Physical Medicine and Rehabilitation, 88(2), 142-9.
Masiero S, et al. Robotic-assisted Rehabilitation of the Upper Limb After Acute Stroke. Arch Phys Med Rehabil. 2007;88(2):142-9. PubMed PMID: 17270510.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Robotic-assisted rehabilitation of the upper limb after acute stroke. AU - Masiero,Stefano, AU - Celia,Andrea, AU - Rosati,Giulio, AU - Armani,Mario, PY - 2006/05/10/received PY - 2006/08/28/revised PY - 2006/10/25/accepted PY - 2007/2/3/pubmed PY - 2007/3/17/medline PY - 2007/2/3/entrez SP - 142 EP - 9 JF - Archives of physical medicine and rehabilitation JO - Arch Phys Med Rehabil VL - 88 IS - 2 N2 - OBJECTIVE: To investigate whether early therapy with a novel robotic device can reduce motor impairment and enhance functional recovery of poststroke patients with hemiparetic and hemiplegic upper limb. DESIGN: A single-blind randomized controlled trial, with an 8-month follow-up. SETTING: Neurologic department and rehabilitation hospital. PARTICIPANTS: Thirty-five patients with acute (< or =1 wk of onset), unilateral, ischemic embolic, or thrombotic stroke. INTERVENTIONS: Patients of both groups received the same dose and length per day of standard poststroke multidisciplinary rehabilitation. Patients were randomly assigned to 2 groups. The experimental group (n=17) received additional early sensorimotor robotic training, 4 hours a week for 5 weeks; the control group (n=18) was exposed to the robotic device, 30 minutes a week, twice a week, but the exercises were performed with the unimpaired upper limb. Training by robot consisted of peripheral manipulation of the shoulder and elbow of the impaired limb, correlated with visual stimuli. MAIN OUTCOME MEASURES: The Fugl-Meyer Assessment (FMA) of upper-extremity function (shoulder/elbow and coordination and wrist/hand subsections) to measure each trained limb segment; the Medical Research Council (MRC) score to measure the strength of muscle force during 3 actions: shoulder abduction (MRC deltoid), elbow flexion (MRC biceps), and wrist flexion (MRC wrist flexors); the FIM instrument and its motor component; and the Trunk Control Test (TCT) and Modified Ashworth Scale (MAS). RESULTS: Compared with the patients in the control group, the experimental group showed significant gains in motor impairment and functional recovery of the upper limb after robot therapy, as measured by the MRC deltoid (P< or =.05) and biceps (P<.05) scores, the FMA for the proximal upper arm (P<.05), the FIM instrument (P<.05), and the FIM motor score (P<.01); these gains were also sustained at the 3- and 8-month follow-up. The FMA and MRC wrist flexor test findings did not differ statistically either at the end of training or at the follow-up sessions. We found no significant differences in MAS and TCT in either group in any of the evaluations. No adverse effects occurred and the robotic approach was very well accepted. CONCLUSIONS: Patients who received robotic therapy in addition to conventional therapy showed greater reductions in motor impairment and improvements in functional abilities. Robotic therapy may therefore effectively complement standard rehabilitation from the start, by providing therapeutic support for patients with poststroke plegic and paretic upper limb. SN - 0003-9993 UR - https://www.unboundmedicine.com/medline/citation/17270510/Robotic_assisted_rehabilitation_of_the_upper_limb_after_acute_stroke_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-9993(06)01482-1 DB - PRIME DP - Unbound Medicine ER -