Recovery of hand function with robot-assisted therapy in acute stroke patients

Abstract

In the last few years, not many studies on the use of robot-assisted therapy to recover hand function in acute stroke patients have been carried out. This randomized-controlled observer trial is aimed at evaluating the effects of intensive robot-assisted hand therapy compared with intensive occupational therapy in the early recovery phases after stroke with a 3-month follow-up. Twenty acute stroke patients at their first-ever stroke were enrolled and randomized into two groups. The experimental treatment was performed using the Amadeo Robotic System. Control treatment, instead, was carried out using occupational therapy executed by a trained physiotherapist. All participants received 20 sessions of treatment for 4 consecutive weeks (5 days/week). The following clinical scales, Fugl-Meyer Scale (FM), Medical Research Council Scale for Muscle Strength (hand flexor and extensor muscles) (MRC), Motricity Index (MI) and modified Ashworth Scale for wrist and hand muscles (MAS), were performed at baseline (T0), after 20 sessions (end of treatment) (T1) and at the 3-month follow-up (T2). The Barthel Index was assessed only at T0 and T1. Evidence of a significant improvement was shown by the Friedman test for the FM [experimental group (EG): P=0.0039, control group (CG): P<0.0001], Box and Block Test (EG: P=0.0185, CG: P=0.0086), MI (EG: P<0.0001, CG: P=0.0303) and MRC (EG: P<0.0001, CG: P=0.001) scales. These results provide further support to the generalized therapeutic impact of intensive robot-assisted treatment on hand recovery functions in individuals with acute stroke. The robotic rehabilitation treatment may contribute toward the recovery of hand motor function in acute stroke patients. The positive results obtained through the safe and reliable robotic rehabilitation treatment reinforce the recommendation to extend it to a larger clinical practice.

Effect of Upper Extremity Robot-Assisted Exercise on Spasticity in Stroke Patients

“…Sale et al [38] and Hesse et al [39] reported decreases in spasticity and improvements in motor ability; whereas, Masiero et al [10], Chang et al [14], and Fasoli et al [11] reported that spasticity did not significantly decrease despite improvement in upper extremity function and muscle strength.…”

Is robot-assisted therapy effective in upper extremity recovery in early stage stroke? —a systematic literature review

“…According to the study reported by Duncan et al21 ) because the recovery of motor function in stroke patients occurs rapidly within the first few weeks of onset, stroke rehabilitation in the early stage has an important role in recovery of motor function. The application of robotics to upper extremity rehabilitation in stroke rehabilitation is increasing, and a variety of associated studies is being carried out17, 18 ) . According to the previous study22 ) , upper extremity robot-assisted therapy improves not only upper extremity function, but also activities of daily living in stroke.…”

“…Robot applied in the distal part of upper extremity was effectiveness in reducing spasticity17 ) . Robot applied in the proximal part robot of upper extremity was effectiveness in improvement of motor function and increase in range of motion15,16,17,18, 24 ) . Moreover, whole upper extremity robots showed improved motor function of the proximal upper extremity and activities of daily living and recovery of upper extremity function19 ) .…”

Exercising daily living activities in robot-mediated therapy

“…Task difficulty level, the joints involved and the number of repetitions are adjustable. This kind of robot-assisted therapy proved to be effective in acute5 ) , subacute6 ) , and chronic7 ) state post-stroke according to several clinical trials8 ) .…”