Effect of Gravity on Robot-Assisted Motor Training After Chronic Stroke: A Randomized Trial

Abstract

Objectives To determine the efficacy of 2 distinct 6-week robot-assisted reaching programs compared with an intensive conventional arm exercise program (ICAE) for chronic, stroke-related upper-extremity (UE) impairment. To examine whether the addition of robot-assisted training out of the horizontal plane leads to improved outcomes. Design Randomized controlled trial, single-blinded, with 12-week follow-up. Setting Research setting in a large medical center. Participants Adults (N=62) with chronic, stroke-related arm weakness stratified by impairment severity using baseline UE motor assessments. Interventions Sixty minutes, 3 times a week for 6 weeks of robot-assisted planar reaching (gravity compensated), combined planar with vertical robot-assisted reaching, or intensive conventional arm exercise program. Main Outcome Measure UE Fugl-Meyer Assessment (FMA) mean change from baseline to final training. Results All groups showed modest gains in the FMA from baseline to final with no significant between group differences. Most change occurred in the planar robot group (mean change ± SD, 2.94± 0.77; 95% confidence interval [CI], 1.40 – 4.47). Participants with greater motor impairment (n=41) demonstrated a larger difference in response (mean change ± SD, 2.29±0.72; 95% CI, 0.85–3.72) for planar robot-assisted exercise compared with the intensive conventional arm exercise program (mean change ± SD, 0.43±0.72; 95% CI, −1.00 to 1.86). Conclusions Chronic UE deficits because of stroke are responsive to intensive motor task training. However, training outside the horizontal plane in a gravity present environment using a combination of vertical with planar robots was not superior to training with the planar robot alone.

Guidelines for Adult Stroke Rehabilitation and Recovery

“…704,705 Overall, robotic therapy appears to provide some benefit for upper extremity motor abilities and participation but is of uncertain utility compared with dose-matched conventional upper limb exercise therapies. [706][707][708][709][710][711][712][713] NMES can be used for those with minimal ability for volitional muscle activation. It may be beneficial for improving upper extremity activity if used in combination with taskspecific training, particularly when applied to the wrist and hand muscles.…”

Timing of motor cortical stimulation during planar robotic training differentially impacts neuroplasticity in older adults

“…Robotic rehabilitation devices assist massed practice of upper extremity movement at high repetition rates (Lo et al, 2010, Conroy et al, 2011). They can also be used to change the learning environment, e.g., provide assistance or resistance to the motor task or train new mappings for movement to environmental effect (Krebs et al, 1998, Stein et al, 2004, MacClellan et al, 2005).…”

Upper Limb Rehabilitation Using a Planar Cable-Driven Parallel Robot with Various Rehabilitation Strategies

“…According to the clinical trials data, the planar robot inspired by 2D gravity-compensated therapy is more effective than 3-D spatial therapy [9]. As a first prototype, we developed a deskshaped planar CDPR.…”