Comparison of Robotics, Functional Electrical Stimulation, and Motor Learning Methods for Treatment of Persistent Upper Extremity Dysfunction After Stroke: A Randomized Controlled Trial

Abstract

Severely impaired stroke survivors with persistent (>1y) upper-extremity dysfunction can make clinically and statistically significant gains in coordination and functional task performance in response to robotics plus ML, FES plus ML, and ML alone in an intensive and long-duration intervention; no group differences were found. Additional studies are warranted to determine the effectiveness of these methods in the clinical setting.

Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square programme

“…It is worth comparing the magnitude of the changes with previous reported clinical trials of upper limb rehabilitation. Most obviously, the study by McCabe et al 10 investigated the effects of 300 hours of upper limb rehabilitation in 48 chronic stroke patients with similar characteristics to those reported here (baseline FM-UL 24, compared with 26 in our patients) and reported an increase of 8–11 points on the FM-UL at the end of 300 hours of upper limb treatment (although later follow-up results have not been reported). In the QSUL programme, the median FM-UL (modified) improvement was 6 points after the 90 hours programme, increasing to 9 points by 6-months follow-up, achieving a similar overall magnitude of change in comparison to McCabe et al .…”

“…A common factor in these trials is that the dose (in hours) of additional therapy remained relatively low (18–36 hours). Despite scepticism that stroke patients could tolerate much higher doses,8 one study managed to deliver 300 hours of upper limb therapy to chronic stroke patients over 12 weeks and reported changes in measures of both impairment and activity that were far greater than those in lower dose studies 10. Three hundred hours represents an order of magnitude higher than any dose of rehabilitation offered in previous upper limb rehabilitation trials and deserves further consideration.…”

Randomized Trial on the Effects of Attentional Focus on Motor Training of the Upper Extremity Using Robotics With Individuals After Chronic Stroke

“…[42][43][44] It is worth noting that the participants in the EF group completed more repetitions per session (mean, 935.1) than the IF group (mean, 883.8). Reasons for reduced dosage for both groups included arriving late/transportation issues and complaints of fatigue (especially during early sessions; this improved over time as subjects got used to the protocol).…”

Robust compensation of electromechanical delay during neuromuscular electrical stimulation of antagonistic muscles

“…Besides, when combined with traditional motor training, the clinical NMES treatment will cost significantly less than using robotic therapy, the difference can be up to $1,000 per patient while achieving the same degree of recovery [42].…”