Reaching exercise for chronic paretic upper extremity after stroke using a novel rehabilitation robot with arm-weight support and concomitant electrical stimulation and vibration: before-and-after feasibility trial

Abstract

Background Our group developed a rehabilitation robot to assist with repetitive, active reaching movement of a paretic upper extremity. The robot is equipped with a servo motor-controlled arm-weight support and works in conjunction with neuromuscular electrical stimulation and vibratory stimulation to facilitate agonist-muscle contraction. In this before-and-after pilot study, we assessed the feasibility of applying the robot to improve motor control and function of the hemiparetic upper extremity in patients who suffered chronic stroke. Methods We enrolled 6 patients with chronic stroke and hemiparesis who, while sitting and without assistance, could reach 10 cm both sagitally and vertically (from a starting position located 10 cm forward from the patient’s navel level) with the affected upper extremity. The patients were assigned to receive reaching exercise intervention with the robot (Yaskawa Electric Co., Ltd. Fukuoka, Japan) for 2 weeks at 15 min/day in addition to regular occupational therapy for 40 min/day. Outcomes assessed before and after 2 weeks of intervention included the upper extremity component of the Fugl-Meyer Assessment (UE-FMA), the Action Research Arm Test (ARAT), and, during reaching movement, kinematic analysis. Results None of the patients experienced adverse events. The mean score of UE-FMA increased from 44.8 [SD 14.4] to 48.0 [SD 14.4] (p = 0.026, r = 0.91), and both the shoulder–elbow and wrist–hand scores increased after 2-week intervention. An increase was also observed in ARAT score, from mean 29.8 [SD 16.3] to 36.2 [SD 18.1] (p = 0.042, r = 0.83). Kinematic analysis during the reaching movement revealed a significant increase in active range of motion (AROM) at the elbow, and movement time tended to decrease. Furthermore, trajectory length for the wrist (“hand path”) and the acromion (“trunk compensatory movement”) showed a decreasing trend. Conclusions This robot-assisted modality is feasible and our preliminary findings suggest it improved motor control and motor function of the hemiparetic upper extremity in patients with chronic stroke. Training with this robot might induce greater AROM for the elbow and decrease compensatory trunk movement, thus contributing to movement efficacy and efficiency. Trial registration UMIN Clinical Trial Registry, as UMIN000018132, on June 30, 2015. https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000020398

Technology-Based Compensation Assessment and Detection of Upper Extremity Activities of Stroke Survivors: Systematic Review

“…This model (29/63, 46% studies) measures awkward movements of the shoulder of the affected UE [ 15 ], involving complex movements of the shoulder girdle and shoulder joint. The most observed shoulder compensation was shoulder elevation (17/29, 59% studies), followed by shoulder abduction [ 27 , 28 , 64 , 70 , 71 ], shoulder girdle compensatory movement [ 29 - 31 , 64 , 72 ], shoulder forward (protraction) [ 26 , 32 ], and shoulder overflexion [ 22 , 33 , 73 ]. The most commonly used task was reaching task (18/29, 62% studies).…”

“…A total of 3 studies [ 22 , 33 , 73 ] used the shoulder flexion angle to assess the shoulder overflexion compensation. The parameter for measuring shoulder forward compensation was shoulder forward liner displacement [ 26 , 32 ].…”

“…In all, 5 studies have been used as the ground truth for the measurement of the effectiveness of other sensors in compensation detection [ 42 , 43 , 45 , 86 , 87 ]. Several interesting findings were reported using marker-based motion capture systems: (1) pre- and posttests showed that both robotic [ 32 , 38 , 63 ] and MR therapies [ 26 ] elicited benefits on reducing trunk compensatory movements, and stroke survivors showed less trunk compensatory movements during VR reaching [ 24 ]. However, Belfatto et al [ 33 ] argued that robotic therapy promoted the adoption of compensatory movements when stroke survivors performed training tasks; (2) therapist-based therapy [ 62 ] or a combination of robotic therapy and constraint-induced therapy [ 46 ] demonstrated more significant improvements in reducing trunk compensatory movements compared with robot-assisted therapy; (3) trunk displacement and shoulder elevation compensatory movements could discriminate between mild and moderate stroke paresis [ 66 ], whereas shoulder girdle compensatory movement could differentiate between mild or moderate and severe or pronounced stroke impairments [ 72 ].…”

A review of upper limb robot assisted therapy techniques and virtual reality applications

“…In the first study, the evaluation showed an increase in the grey matter in five brain areas which enhanced the motor skills [75]. In [76] the trial focused on reaching abilities in the shoulder and elbow using RAT. The results showed major improvement in skill acquisition for the elbow and shoulder after two weeks of sessions.…”

Simultaneous Control of Tonic Vibration Reflex and Kinesthetic Illusion for Elbow Joint Motion Toward Novel Robotic Rehabilitation

“…Several effective control strategies of rehabilitation robots such as assist-as-needed strategies [5]- [8] have been proposed to take into account the active participation of patients in rehabilitation. Hybrid robotic assistance is one of the emerging technologies in robotic rehabilitation [9]- [11]. In hybrid robotic rehabilitation systems, electric stimulation and/or vibration are/is used in addition to robot assistance to improve motor functions.…”